Histoplasmosis

Abstract

This case history recounts the protracted course of Histoplasma capsulatum infection in a man that recurred after an initial treatment program with amphotericin B. The disease presented first as a granulomatous colonic lesion that was confused with a malignant growth. Subsequently, it reappeared several times in the genitourinary system, the upper and lower respiratory tracts and finally in the oropharynx. Retreatment with amphotericin B was delayed for five years due to the patient's refusal to take this medication because of the serious complications from nephrotoxicity and potassium loss that occurred following the initial course of amphotericin B therapy. The protracted use of sulfadiazine had no beneficial effect on the disease nor did the empiric administration of immune globulin modify the course of the disease. Control of the infection was finally achieved after treatment with amphotericin B was reinstituted but in a prolonged course of suboptimal amounts. It was found that the intravenous administration of 25 mg. weekly for a total of 1.030 gm. was well tolerated and caused no morbidity, yet led to remission (now of thirty months' duration). We suggest that this modification in amphotericin B usage deserves further trial.