scholarly journals A Case Of Disseminated Histoplasmosis In A Patient With Sarcoidosis

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S98-S99
Author(s):  
I Prisneac ◽  
J Vos ◽  
R LaSala ◽  
C Randall
Keyword(s):  
Bone Marrow ◽  
Correct Diagnosis ◽  
Cell Activity ◽  
Immunocompetent Patient ◽  
Lymph Node Biopsy ◽  
Disseminated Histoplasmosis ◽  
Bone Marrow Cultures ◽  
History Of ◽  
Intravenous Amphotericin ◽  
Noncaseating Granulomas

Abstract Introduction/Objective Sarcoidosis is a syndrome of unknown cause that may manifest with clinical, radiographic and pathological findings similar to those seen with histoplasmosis. We present a case of disseminated histoplasmosis in an immunocompetent patient previously diagnosed with sarcoidosis. Methods/Case Report A 69-year-old obese male with a history of hypertension, diabetes mellitus and long-standing sarcoidosis was admitted to the hospital for several months of intermittent fevers and pancytopenia. His sarcoidosis was diagnosed 21 years prior, initially involving the lungs and eventually showing cardiac involvement, requiring a pacemaker. He had been treated with methotrexate and prednisone. His recent medical history was also significant for COVID-19 infection, diagnosed 3 months before admission. His fevers were initially attributed to sarcoidosis and his pancytopenia to methotrexate. However, his symptoms continued despite discontinuation of his medications, and further workup was initiated. Computed tomography showed hepatomegaly, splenomegaly, and lymphadenopathy, concerning for a lymphoproliferative disorder. The patient underwent a bone marrow biopsy that showed noncaseating granulomas and microorganisms consistent with histoplasmosis on fungal stain. Bone marrow cultures were not possible as the marrow was inaspirable. The patient subsequently underwent a lymph node biopsy with both morphology and culture identifying histoplasmosis. Urine and serum histoplasma antigen also returned positive. The patient’s overall clinical picture was consistent with disseminated histoplasmosis and he was administered intravenous Amphotericin B for 3 weeks followed by oral itraconazole for 1 year. One month follow-up after discharge showed significant improvement in the patient’s condition. Results (if a Case Study enter NA) N/A Conclusion Sarcoidosis reduces T-cell activity, and treatment with steroids causes further immunosuppression and vulnerability for development of a disseminated infection. COVID-19 also presumably increases the predisposition to acquire bacterial or fungal co-infections. Clinicians and pathologists should be aware of the overlap in clinical, radiologic and pathological presentations of sarcoidosis and histoplasmosis to make the correct diagnosis and administer the appropriate treatment.

scholarly journals Typical Facial Lesions: A Window of Suspicion for Progressive Disseminated Histoplasmosis—A Case of Asian Prototype

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Prasan K. Panda ◽  
Siddharth Jain ◽  
Rita Sood ◽  
Rajni Yadav ◽  
Naval K. Vikram
Keyword(s):  
Histoplasma Capsulatum ◽  
Bone Marrow Aspiration ◽  
Febrile Illness ◽  
Immunocompetent Patient ◽  
Dimorphic Fungus ◽  
Recent Onset ◽  
Disseminated Histoplasmosis ◽  
The Face ◽  
History Of ◽  
Progressive Disseminated Histoplasmosis

Histoplasmosis is caused by a dimorphic fungusHistoplasma capsulatumin endemic areas, mainly America, Africa, and Asia. In India, it is being reported from most states; however, it is endemic along the Ganges belt. We report a case of an apparently immunocompetent male who presented with 3-month history of fever, cough, and weight loss with recent onset odynophagia and had hepatosplenomegaly and mucocutaneous lesions over the face. The differential diagnosis of leishmaniasis, tuberculosis, leprosy, fungal infection, lymphoproliferative malignancy, and other granulomatous disorders was considered, but he succumbed to his illness. Antemortem skin biopsy and bone marrow aspiration along with postmortem liver, lung, and spleen biopsy showed disseminated histoplasmosis. This case highlights the need for an early suspicion of progressive disseminated histoplasmosis in the presence of classical mucocutaneous lesions even in an immunocompetent patient suffering from a febrile illness. Cure rate approaches almost 100% with early treatment, whereas it is universally fatal if left untreated.

scholarly journals Pediatric Cryptococcal Lymphadenitis in the Absence of AIDS: Case Report and Literature Review

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Fengchang Bao ◽  
Hongna Tan ◽  
Wei Liu ◽  
Yange Li ◽  
Huixia Li
Keyword(s):  
Lymph Nodes ◽  
Bone Marrow Aspiration ◽  
Excisional Biopsy ◽  
Lymph Node Biopsy ◽  
Cervical Lymph Nodes ◽  
Oral Fluconazole ◽  
Reactive Protein ◽  
History Of ◽  
Eosinophil Granulocytes ◽  
Intravenous Amphotericin

We present a rare case of cryptococcal lymphadenitis without immunocompromization in a two-and-a-half-year-old child. He was referred to our center with a fifteen-day history of continued fever. Ultrasound and computed tomography (CT) revealed the enlargement of multiple lymph nodes and lung reticulonodular shadows. Hematological, immunological, and microbiological tests for hepatitis, lymphoma, AIDS, and immunoglobulin deficiencies were negative. Laboratory tests demonstrated elevated erythrocyte sedimentation rate, elevated plasma and urinary ß2-microglobulin (ß2-MG) levels, and elevated C-reactive protein and fibrinogen. Both blood routine and bone marrow aspiration showed elevated eosinophil granulocytes. The diagnosis of cryptococcal lymphadenitis was obtained by excisional biopsy of the cervical lymph nodes. The patient was treated with intravenous amphotericin B and oral flucytosine for five weeks, then with subsequent oral fluconazole for three months. The patient is now doing well. Our case suggests that the diagnosis of cryptococcal lymphadenitis is very difficult without etiology and pathology, especially for a patient with a normal immune system; lymph node biopsy is necessary to diagnose it, and immediate antifungal treatment is necessary to treat it.

scholarly journals Cutaneous Manifestations of Disseminated Histoplasmosis in a Patient with AIDS

2018 ◽  
Vol 2 (4) ◽  
pp. 256-260
Author(s):  
Luis J Borda ◽  
Kate E Oberlin ◽  
Anna J Nichols
Keyword(s):  
Systemic Disease ◽  
Adequate Treatment ◽  
Cutaneous Manifestations ◽  
Disseminated Histoplasmosis ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
History Of ◽  
Oral Itraconazole ◽  
Intravenous Amphotericin ◽  
Immunodeficiency Syndrome

Introduction: Disseminated histoplasmosis is often seen in immunocompromised individuals, such those with acquired immunodeficiency syndrome (AIDS). The initial infection mainly involves the lungs but it may develop into a disseminated form especially in immunocompromised patients. Since it can be a systemic disease with cutaneous manifestations, dermatologists must be able to recognize its clinical presentation to ensure prompt management.Case: We present a man in his 50s with past medical history of AIDS who developed disseminated histoplasmosis with skin and gastrointestinal involvement over a one-month period of time. Despite receiving induction therapy with intravenous amphotericin B followed by oral itraconazole, the patient expired. His death was attributed to his persistently low CD4 T-cell count and secondary bacteremia.Discussion: This condition should be recognized early and treated aggressively. However, patients with multiple comorbidities are at increased risk of mortality even despite adequate treatment. This case highlights the significant mortality risk of disseminated histoplasmosis in patients with AIDS.

scholarly journals P039 Muscle wasting & weakness: a rare presentation of sarcoidosis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Clare Tomlinson ◽  
Asim Khan ◽  
Debashish Mukerjee ◽  
Naveen Bhadauria
Keyword(s):  
Lower Limb ◽  
Muscle Wasting ◽  
Correct Diagnosis ◽  
Lower Limbs ◽  
High Dose ◽  
Rare Presentation ◽  
Multisystem Disease ◽  
Limb Weakness ◽  
History Of ◽  
Noncaseating Granulomas

Abstract Background/Aims  Sarcoidosis is a rare multisystem disease characterised by the presence of noncaseating granulomas. It most commonly affects the lungs though can affect any other organ system. Rarely, it can manifest as an acute myopathy. We describe a case of a patient presenting with muscle weakness and constitutional symptoms who was eventually diagnosed with sarcoidosis. Methods  A 48-year-old male with a background of lumbar spondylosis and BPH, presented with a 6-week history of progressive upper and lower limb weakness, myalgia and reduced mobility. He also described an 18-month history of progressive fatigue, drenching night sweats and 10-kilogram weight loss. His symptoms meant he was unable to work as a firefighter. Examination demonstrated profound muscle wasting and reduced power in the proximal muscles of his upper and lower limbs. There was no evidence of rash, synovitis or lymphadenopathy. Blood tests showed a normocytic anaemia (Hb 100 g/L) and raised C-reactive peptide (180 mg/L) and erythrocyte sedimentation rate (100 mm/hour). The creatine kinase ranged between 20-42 units/litre. He had a weakly positive anti-nuclear antibody (1:80). The remaining autoantibody screen was negative including ENA, DSDNA, ANCA, rheumatoid factor and anti-CCP. Complement proteins were unremarkable. Furthermore, an extended myositis panel revealed no myositis-specific or myositis-associated antibodies. Serum calcium and angiotensin-converting enzyme (ACE) levels were normal. Blood cultures and virology screen including for HIV, hepatitis B, hepatitis C, CMV, EBV, COVID-19 and respiratory viruses were all negative. A chest radiograph was also unremarkable. Results  He subsequently underwent electromyography which revealed generalised myopathy. An MRI of the lower limb proximal musculature showed evidence of muscle oedema worse on the right-side but no definitive evidence of myositis. A PET-CT followed revealing FDG-avid generalised lymphadenopathy and polyarticular uptake, but little uptake in the skeletal muscles. He underwent an external iliac lymph node core biopsy which demonstrated multiple noncaseating granulomas and lymphadenitis. Cultures for Tuberculosis were negative and there was no evidence of a lymphoproliferative disorder. A muscle biopsy was desired but not possible due to lack of availability because of the COVID-19 pandemic. The patient was diagnosed with sarcoidosis and commenced on three pulses of intravenous methylprednisolone followed by a weaning regimen of high-dose oral prednisolone and subcutaneous methotrexate. This resulted in a sustained improvement in his symptoms and normalisation of inflammatory markers. Conclusion  Symptomatic myopathy is present in only 0.5-2.5% of sarcoidosis patients. This unique case highlights the heterogeneity of this disease and the vital role different diagnostic modalities play in achieving the correct diagnosis. It is also pertinent that the lymphadenopathy, found incidentally via imaging, led to the diagnosis. Although notoriously a diagnosis of exclusion, this case emphasises the importance of considering sarcoidosis even in the absence of respiratory symptoms, a raised ACE or hypercalcaemia. Disclosure  C. Tomlinson: None. A. Khan: None. D. Mukerjee: None. N. Bhadauria: None.

scholarly journals A Case Report: Angioimmunoblastic T Cell Misdiagnosed as Pulmonary Sarcoidosis

2021 ◽  
Author(s):  
xuerui Wang ◽  
Xu jie ◽  
Chen guang ◽  
bingyan Zhan
Keyword(s):  
Bone Marrow ◽  
Lymph Node ◽  
T Cell ◽  
Bone Marrow Biopsy ◽  
Cell Lymphoma ◽  
Clinical Manifestations ◽  
Pulmonary Sarcoidosis ◽  
Lymph Node Biopsy ◽  
Node Biopsy ◽  
History Of

Abstract Introduction: Angioimmunoblastic T-cell lymphoma is a peripheral T-cell lymphoma subtype characterized by abnormal proliferation of T lymphocytes with hyperplasia of endothelial veins and follicular dendritic cells. Sarcoidosis is a non-caseating epithelial granulomatous disease of unknown cause, which can invade the whole body organs, especially the lungs and intrathoracic lymph nodes. The clinical manifestations are not specific. There are many similarities between the malignant lymphoma and pulmonary sarcoidosis in the early clinical manifestations, such as chest imaging and clinical manifestations, which are easy to be misdiagnosed. Methods: A fifty-three-year-old man presented with a two-month history of cough. This article uses the clinical data of a patient to reveal the main points that should be paid attention to in the diagnosis of lymphoma.Results: The patient were given right inguinal lymph node biopsy and bone marrow biopsy. Case Presentation: Here, A fifty-three-year-old man presented with a two-month history of cough. The effect was not good after one week of anti-infective and glucocorticoid treatment. Lymph node biopsy and bone marrow biopsy were performed. Conclusion: When we find that the therapeutic effect of pulmonary sarcoidosis is not good, we should make pathological diagnosis. We can prevent further deterioration of the disease through the above measures.

A Rare Case of Tuberculous Prostatitis

2016 ◽  
Vol 1 (2) ◽  
pp. 33
Author(s):  
Nurul Yaqeen Mohd Esa ◽  
Mohammad Hanafiah ◽  
Marymol Koshy ◽  
Hilmi Abdullah ◽  
Ahmad Izuanuddin Ismail ◽  
...  
Keyword(s):  
Rare Case ◽  
Correct Diagnosis ◽  
Immunocompetent Patient ◽  
Clinical Suspicion ◽  
Tuberculosis Infection ◽  
Advanced Age ◽  
Immunocompromised Patients ◽  
Prostatic Biopsy ◽  
High Clinical Suspicion

Tuberculous prostatitis is an uncommon form of tuberculosis infection. It is commonly seen in immunocompromised patients and in those of middle or advanced age. The diagnosis is often not straight forward due to the nature of its presentation. We report a case of tuberculous prostatitis in a young, healthy and immunocompetent patient, who initially presented with respiratory features, followed by episodes of seizures and testicular swelling. He was finally diagnosed with tuberculous prostatitis after prostatic biopsy. This case illustrates that in a high TB prevalence environment, when symptoms warrant, there should be a high clinical suspicion coupled with a thorough approach in order to arrive at a correct diagnosis of TB prostatitis.

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