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Case Reports
. 2024 Jul 8:45:100658.
doi: 10.1016/j.mmcr.2024.100658. eCollection 2024 Sep.

Disseminated histoplasmosis: Long journey of a febrile young man

Sudip Kumar Banik  1 , Chowdhury Adnan Sami  2 , Md Mizanur Rahman Khan  1 , Shohael Mahmud Arafat  1 , Abed Hussain Khan  1
Affiliations
Case Reports

Disseminated histoplasmosis: Long journey of a febrile young man

Sudip Kumar Banik et al. Med Mycol Case Rep. .

Abstract

A 19-year-old non-diabetic, non-HIV male presented with eighteen months of fever, weight loss, skin rash and lymphadenopathy. He was treated with anti-tubercular medication for more than twelve months in multiple institutions based on repeated biopsy reports of lymph nodes showing granuloma suggestive of tuberculosis. Before he was diagnosed at Bangabandhu Sheikh Mujib Medical University (BSMMU) with disseminated histoplasmosis at eighteen months of his disease, he already lost twenty kg weight, developed multiple small joint pain, back pain, and cough along with previously mentioned symptoms. Extensive investigations at BSMMU revealed biopsy material from multiple sites showed noncaseating granulomas with Periodic acid-Schiff (PAS) stain positive for budding oval yeast cells, and fungal culture revealed growth of dimorphic fungus suggestive of Histoplasma after three weeks. After treatment with intravenous liposomal amphotericin B with continuous itraconazole, the patient's fever completely subsided, his well-being improved, joint pain reduced, started to gain weight, and skin lesions started to heal. This case serves as a significant reminder that it is imperative to consider alternative diagnoses in patients who fail to show improvement with conventional antitubercular treatment.

Keywords: Bangladesh; Disseminated histoplasmosis; Fungus; Histoplasma; PDH; PUO.

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Figures

Fig. 1
Fig. 1
Before and after changes in appearances and skin lesions of LAmB therapy.
Fig. 2
Fig. 2
A) lytic lesions in X-ray hand (arrows), (B) and (C) pre- and para-vertebral soft tissue abscesses with disc involvement.
Fig. 3
Fig. 3
(A) Bone marrow trephine biopsy (B) skin biopsy; both showed noncaseating granulomas intracellular and extracellular small oval budding yeast cell.
See this image and copyright information in PMC

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