Histoplasma capsulatum in New England: A Case Study

Abstract

1. Lori-Ann Camara, MLS(ASCP)CM 1. St. Luke's Hospital, New Bedford, MA 02740 2. Katerina Miraglia, D.C., MLS(ASCP)CM 1. Department of Medical Laboratory Science, University of Massachusetts, Dartmouth, MA 02747-2300 3. Susan J. Leclair, Ph.D.[⇑][1] 1. Department of Medical Laboratory Science, University of Massachusetts, 285 Old Westport Road, Dartmouth, MA 1. Address for Correspondence: Susan J. Leclair, Ph.D., Department of Medical Laboratory Science, University of Massachusetts, 285 Old Westport Road, Dartmouth, MA 02747-2300, 508-999-8786, sleclair{at}umassd.edu Overview: A healthy adult experienced a necrotic lesion on her back. She developed a reduced appetite, profound weakness, and fever. Routine x-rays and CAT scans demonstrated bilateral hilar adenopathy and patchy infiltrates. During bronchoscopy, biopsies and cultures for bacteria and fungi were taken. Patient History: A 24-year-old female was admitted to the hospital after treatment by her primary care physician for a necrotic skin lesion on her back. She is a social worker in a large urban area in the Northeast quadrant of the country and recently returned from a vacation in Honduras where she experienced a “bite” on her back. Approximately 10 days after her return, she experienced generalized weakness, night sweats, chills and headaches. She also states that she has experienced a significant drop in appetite. She did not complain of any chest pain but commented about heaviness behind her sternum. Medical imaging confirmed the presence of abdominal and inguinal adenopathy. The only relevant family history included a parent with COPD due to smoking and a paternal uncle with sarcoidosis. Given the continued presence of a now necrotic lesion, her primary care physician initiated a course of doxycycline for a suspected rickettsial infection. The necrotic lesion resolved but the systemic symptoms persisted and, together with the imagining results, a bronchoscopy was justified. Relevant Medical History: The patient has been healthy although her childhood medical history includes bouts of asthma that diminished over time. She stated that she has not have an instance of asthma for at least 10… ABBREVIATIONS: COPD – Chronic Obstructive Pulmonary Disease, CBC – Complete Blood Count, BUN – Blood Urea Nitrogen, EBV – Epstein Barr Virus, CMV – Cytomegalovirus, AIDS – Autoimmune Deficiency Syndrome [1]: #corresp-1