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- Title
Disseminated Histoplasmosis with bone marrow infiltration secondary to untreated human immunodeficiency virus/acquired immune deficiency syndrome.
- Authors
Fong, Ashlyn; Mahe, Etienne
- Abstract
The diagnostic workup of infectious disease in immunosuppressed patients can be challenging. Here we discuss the case of a 49-year-old man with untreated HIV/AIDS with an uncommon initial presentation of disseminated histoplasmosis which included bone marrow involvement. At presentation, the patient was febrile and neutropenic with a very low CD4 count. Chest imaging showed peripheral lung nodules consistent with a fungal process and blood cultures were positive for fungaemia. Bronchoscopy cultures were negative but fluid galactomannan was positive. Bone marrow biopsy was notable for abundant histiocytes containing microorganisms suggestive of Histoplasma. Given that disseminated histoplasmosis is known to cause false positive galactomannan testing, blood Histoplasma antigen testing was undertaken and was positive. Soon after, blood cultures yielded positive growth for H. capsulatum. While histoplasmosis remains the most common AIDS-defining illness in Histoplasma-endemic areas in the post-treatment era of HIV/AIDS, this case highlights potential difficulties in the diagnostic workup of acutely ill HIV/AIDS infected patients, and the potential of histoplasmosis for manifesting as disseminated disease.
- Subjects
HISTOPLASMOSIS; COMMUNICABLE diseases; HISTOPATHOLOGY; PATHOLOGICAL physiology; PATHOLOGISTS
- Publication
Canadian Journal of Pathology, 2021, Vol 13, Issue 1, p41
- ISSN
1918-915X
- Publication type
Article