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Case Reports
. 2021 Nov;62(11):1231-1236.
doi: 10.1007/s00108-021-01090-1. Epub 2021 Jul 12.

[Puzzling B symptoms in a 61-year-old patient under treatment for rheumatoid arthritis]

[Article in German]
R Wüstenberg  1   2 , M Christner  3 , S Schmiedel  4 , A Tariparast  5 , D Wichmann  5 , M Lennartz  6 , H Klose  7 , S Kluge  5
Affiliations
Case Reports

[Puzzling B symptoms in a 61-year-old patient under treatment for rheumatoid arthritis]

[Article in German]
R Wüstenberg et al. Internist (Berl). 2021 Nov.

Abstract
in English, German

A patient with rheumatoid arthritis and immunosuppression developed symptoms of wasting, neuropathy and lung cavitations eventually leading to central nervous system symptoms and fatal multi-organ failure. Disseminated infection with Histoplasma capsulatum proved to be the underlying cause. The primary infection had apparently been acquired 4 years earlier on a holiday to the Caribbean. Rare infectious diseases should be considered in patients under immunosuppression and travel activities to specific endemic areas.

Ein Patient mit rheumatoider Arthritis sowie B‑Symptomatik, Polyneuropathie und einschmelzenden Lungenveränderungen unter Immunsuppression entwickelte nach zunächst subakutem Verlauf rasch progrediente zentrale neurologische Symptome und ein letales Multiorganversagen. Als ursächlich erwies sich eine disseminierte Infektion mit Histoplasma capsulatum unter Beteiligung des zentralen Nervensystems. Die Erstinfektion hatte sich fünf Jahre zuvor bei einem Karibikurlaub ereignet. Die Kombination aus Reiseaktivität und Immunsuppression erfordert die Berücksichtigung sonst in Deutschland sehr seltener infektiologischer Diagnosen.

Keywords: Bronchoalveolar lavage fluid/lymphocytosis; Granuloma; Histoplasmosis; Immunosuppression; Lung caverns.

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References

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