Disseminated Histoplasmosis with Concurrent Hairy Cell Leukemia.

Abdul Moiz Khan,Sheikh Raza Shahzad,Saleh Najjar,Llewellyn Foulke

doi:10.7759/cureus.6825

Abstract

Histoplasmosis is an endemic fungal infection that can lead to disseminated disease, especially in immunosuppressed patients. Hairy cell leukemia is a rare, slow-growing hematological malignancy. Concurrence of histoplasmosis and hairy cell leukemia is extremely rare. We describe a 69-year-old male who presented with fever, dry cough, pancytopenia, multiple pulmonary nodules, and massive splenomegaly. Histoplasma urinary antigen was positive and disease was confirmed by biopsy of lung lesions. Peripheral smear showed ‘hairy cells’, and bone marrow biopsy revealed findings of hairy cell leukemia. The patient was treated with intravenous amphotericin, followed by oral itraconazole. After the initial treatment of infection, treatment for hairy cell leukemia was started with cladribine. We will discuss the principles of treating disseminated histoplasmosis in the setting of immunosuppression, and hairy cell leukemia with coexisting infection.

Highlights

Histoplasmosis is the leading mycosis in terms of prevalence, hospitalization and mortality in the USA [1]
We present a case of disseminated histoplasmosis in a patient with previously undiagnosed hairy cell leukemia
Constitutional symptoms like fatigue, fever, night sweats, weight loss and anorexia, and clinical findings including splenomegaly, hepatomegaly, pancytopenia, lymphadenopathy, pulmonary infiltration and bony involvement can occur in both hairy cell leukemia and disseminated histoplasmosis [2,8]

Summary

Introduction

Histoplasmosis is the leading mycosis in terms of prevalence, hospitalization and mortality in the USA [1]. To the best of our literature review, there are only two detailed case reports with concurrent hairy cell leukemia and disseminated histoplasmosis. We present a case of disseminated histoplasmosis in a patient with previously undiagnosed hairy cell leukemia. Eight weeks after the initial presentation, he was started on cladribine for the treatment of hairy cell leukemia. He remained in close outpatient follow-up with both infectious disease and hematology. He showed great response to the treatment of both the Histoplasmosis and hairy cell leukemia with significant improvement in the symptoms over the few months. At 14 months from the initial presentation, the patient has completed the antifungal treatment and the leukemia is in remission

Discussion

Conclusions

Disclosures

Findings

Kraut EH

15. Grever MR