African histoplasmosis – an underdiagnosed tropical disease in Ghana

Abstract

African histoplasmosis is a mycotic infection mostly confined to Madagascar, Western and Central Africa with a few rare cases reported outside these endemic areas. Despite being in the endemic zone, few cases have been reported from Ghana. A 36 year old woman developed inexplicable left knee pain and four months later noticed nodular eruptions at the posterior aspect of her neck which subsequently spread to involve other body areas. She had associated generalized lymphadenopathy but no constitutional symptoms and screening for human immune-deficiency virus was negative. Biopsy confirmed African histoplasmosis and after fourteen months treatment with itraconazole during which she experienced periods of remission and relapse, symptoms resolved. Clinicians in African histoplasmosis endemic regions need to consider this diagnosis in patients presenting with systemic mycosis. Though treatment is generally rewarding, prolonged periods of treatment are required as well as long term follow up due to frequent relapse.