A RARE CASE OF ACUTE DISSEMINATED HISTOPLASMOSIS IN AN IMMUNOCOMPETENT PATIENT

Abstract

TYPE: Abstract Publication TOPIC: Chest Infections PURPOSE: Acute Disseminated Histoplasmosis is systemic infection caused by the fungus Histoplasma capsulatum. Although rarely seen in immunocompetent individuals, it should always be included amongst differential diagnoses in patients presenting with respiratory symptoms from endemic regions. METHODS: CXR, CT Chest, Blood/sputum cultures, CBC, CMP, Histoplasma Ag, HIV, Hepatitis, Viral panel, Cortisol levels. RESULTS: A 33 y.o. male presented with worsening dyspnea for 2 weeks with associated fever, chills, cough, nausea, vomiting and diarrhea. Chest x-ray showed extensive parenchymal nodules favoring miliary pattern. CT chest showed extensive diffuse pulmonary nodules with lymphadenopathy, interlobular septal thickening, and hepatosplenomegaly. HIV, hepatitis, and other immunodeficiency workup was unremarkable. Patient underwent bronchoscopy with BAL. Eventually, it was revealed patient's occupation involved him digging trenches, which left him covered in dirt. There was suspicion for acute disseminated histoplasmosis as this was endemic in the region's soil. Histoplasma antigen returned positive. Patient was started on antifungal treatment and his clinical condition improved considerably. CONCLUSIONS: Acute disseminated histoplasmosis occurs when Histoplasma capsulatum spreads beyond pulmonary involvement to include other organs such as the liver, spleen, skin, and lymph nodes. Labwork includes leukopenia, thrombocytopenia, and transaminitis. It's quite unsual to see cases of acute disseminated Histoplasmosis in immunocompetent individuals as opposed to immunodeficient patients. CLINICAL IMPLICATIONS: If untreated, progressive disseminated histoplasmosis can have a mortality of up to at least 85% versus 25% if treated. Disease severity is affected by age, HIV status, malignancy, and corticosteroid use. Treatment with Itraconazole is adequate in mild-moderate progressive disemminated histoplasmosis, whereas severe cases require Amphotericin B followed by Itraconazole course. DISCLOSURE: No significant relationships. KEYWORD: Histoplasmosis