Disseminated Histoplasmosis: Case Report and Review

摘要

Histoplasmosis is a systemic fungal disease. It is also called as Darling’s disease, as it was first described by an American physician named Samuel Taylor Darling, in Panama. It is caused by the dimorphic fungus Histoplasma capsulatum. It is usually self-limiting or localized in immunocompetent individuals whereas in immunocompromised patients, it presents in disseminated forms. This infection is endemic to central and South-central United States.Histoplasmosis infection is acquired by inhalation of fungal microconidia present in the contaminated soil. Asymptomatic dissemination of infection beyond the lungs is common. Infection heals spontaneously in most of the cases and in some cases it develops into pulmonary disease similar to tuberculosis. Dissemination and systemic involvement occurs in patients suffering from debilitating diseases and immunocompromised conditions. It is relatively uncommon in India with few sporadic cases getting reported and it is endemic in eastern part of India. In non-endemic parts, disseminated histoplasmosis is rarely suspected and there have been very few case reports. Awareness is required, as its presentation is similar to tuberculosis, especially when we have patients with compromised immune status. We are reporting with consent one such rare case of disseminated histoplasmosis in a 36-year-old male farmer from South India with acquired immunodeficiency syndrome and very low CD4 count of 17cells/μl with lymph node and bone marrow involvement. Awareness of this infection is essential in these cases as it is potentially lethal and adequately treated patients with antifungal agents carry better prognosis. In non-endemic areas Disseminated Histoplasmosis has to be differentiated from more common disease like tuberculosis, leishmaniasis or systemic malignancies.