Abstract
Central nervous system (CNS) histoplasmosis occurs in 5-20% of all cases and is most commonly seen in immunosuppressed patients who have acquired immunodeficiency syndrome (AIDS) or have received organ transplant. The prevalence of histoplasmosis in patients greater than 65 years old between the years of 1999-2008 in the state of Texas was about 2-3 cases per 100,000 patients year. Since 1990 with the discovery of Triazoles, itraconazole (ICZ) has become the standard initial and suppressive therapy in patients with mild-moderate histoplasmosis without CNS involvement. However, poor penetration of ICZ into the brain, in vitro fluconazole resistance and lack of controlled-trials pose challenge in the treatment of cerebral histoplasmosis.
Highlights
Histoplasmosis is a fungal infection caused by Histoplasma capsulatum which is one of the common fungal respiratory infections, endemic in Africa, Latin America, Asia, central and southeastern states of the United States [1]
Symptomatic cases of infections are seen in patients who are immunocompromised like acquired immunodeficiency syndrome (AIDS), transplant patients on immunosuppressants, patients with ventriculoperitoneal shunts, and patients on steroids [1]
We present a patient with history of adrenal histoplasmosis status post bilateral adrenalectomy presenting with central nervous system (CNS) histoplasmosis despite being on itraconazole (ICZ) therapy
Summary
Histoplasmosis is a fungal infection caused by Histoplasma capsulatum which is one of the common fungal respiratory infections, endemic in Africa, Latin America, Asia, central and southeastern states of the United States [1]. We present a patient with history of adrenal histoplasmosis status post bilateral adrenalectomy presenting with central nervous system (CNS) histoplasmosis despite being on itraconazole (ICZ) therapy. A 56-year-old white male from Texas with history of adrenal histoplasmosis status post bilateral adrenalectomy who had completed two weeks of Amphotericin-B and one year of ICZ treatment presented to us with encephalopathy for one day and weight loss for two months. An initial stereotactic brain biopsy and histoplasma polymerase chain reaction (PCR) were obtained, but after being examined both in house and after being sent to Washington University in St. Louis, MO, the sample was not able to decipher the diagnosis after 3-4 weeks. He was treated with Amphotericin-B for six weeks followed by long-term fluconazole. His neurological impairment improved considerably and he is back to his baseline mental status
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