Haemophagocytic lymphohistiocytosis secondary to disseminated histoplasmosis in an immunocompetent patient

Abstract

Haemophagocytic lymphohistiocytosis secondary to Histoplasma infection is rare and almost always occurs in immunocompromised hosts. We report a 32-year-old immunocompetent man presenting with a nonspecific febrile illness found to have disseminated histoplasmosis and associated haemophagocytic lymphohistiocytosis. The diagnosis was confirmed on histopathological examination and PCR of liver and bone marrow biopsies. He was successfully treated with steroids, intravenous immunoglobulin and itraconazole.

Keywords: Disseminated histoplasmosis; Haemophagocytosis; Histoplasma capsulatum.

Fig. 1

Histopathology of the liver biopsy. (A) CD68 immunohistochemistry highlighting prominent sinusoidal infiltrate of histiocytes in the liver, 100x. (B) Haematoxylin and eosin stain showing histiocytes in liver sinusoids and haemophagocytosis (red arrows) and small round bodies suspicious for fungi (black arrows), 400x. (C) Methenamine silver stain showing fungi consistent with Histoplasma spp.(arrows), 400x. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)