Urine antigen-negative disseminated histoplasmosis mimicking post-transplant lymphoproliferative disorder

2020 ◽  
Vol 13 (6) ◽  
pp. e233976 ◽  
Author(s):  
Surbhi Gupta ◽  
Colin Andrew Hinkamp ◽  
Matthew Lo
Keyword(s):  
Liposomal Amphotericin ◽  
Histoplasma Capsulatum ◽  
Complement Fixation ◽  
Streptococcal Pharyngitis ◽  
Disseminated Histoplasmosis ◽  
Urine Antigen ◽  
History Of ◽  
Multiple Challenges ◽  
Elevated Transaminases ◽  
Antigen Testing

A 50-year-old woman with a history of kidney transplant presented with 2 days of abdominal pain after 6 months of recurrent streptococcal pharyngitis, fevers, weight loss and a new rash on her chest and back. Her examination was notable for a unilateral tonsillar exudate and 2–3 mm pink papules with a fine scale over her chest and back. CT of the abdomen and chest demonstrated several large lymph nodes, and laboratory investigation revealed new cytopenias and elevated transaminases. Urine antigen testing for Histoplasma capsulatum was negative, but a fungal complement fixation panel was reactive for Histoplasma antibodies. Skin biopsy revealed intracellular organisms consistent with H. capsulatum. She underwent treatment with liposomal amphotericin B but due to nephrotoxicity, drug interactions and worsening transaminitis, therapy was changed to itraconazole. The diagnosis and management of disseminated histoplasmosis presents multiple challenges, which are of particular importance in patients with a history of renal transplantation.

Cytologic Diagnosis of Disseminated Histoplasmosis in the Wall of the Urinary Bladder of a Cat

2012 ◽  
Vol 48 (3) ◽  
pp. 203-208 ◽  
Author(s):  
Amanda R. Taylor ◽  
James W. Barr ◽  
Jessica A. Hokamp ◽  
Mark C. Johnson ◽  
Benjamin D. Young
Keyword(s):  
Urinary Bladder ◽  
Histoplasma Capsulatum ◽  
Bladder Wall ◽  
Abdominal Ultrasound ◽  
Cytologic Examination ◽  
Disseminated Histoplasmosis ◽  
Urinary Bladder Wall ◽  
History Of ◽  
Recurrent Hematuria ◽  
Abdominal Ultrasound Examination

A 10 yr old domestic longhair presented with a 2.5 mo history of recurrent hematuria. Abdominal ultrasound examination demonstrated a thickened urinary bladder, abdominal lymphadenopathy, and a thickened and rounded spleen. Cytologic examination of fine-needle aspirate samples revealed Histoplasma capsulatum organisms in the urinary bladder wall and spleen. The cat was treated with itraconazole (10 mg/kg per os q 24 hr for 2.5 wk). The cat was euthanized after 19 days of treatment because of lack of improvement. To the authors’ knowledge, this is the first documented case of feline disseminated histoplasmosis diagnosed in the urinary bladder wall.

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 SEPTIC SHOCK IN PATIENT WITH DISSEMINATED HISTOPLASMOSIS ASSOCIATED WITH AIDS: A CASE REPORT

2013 ◽  
Vol 55 (4) ◽  
pp. 283-286
Author(s):  
Fabiano de Oliveira Poswar ◽  
Jair Almeida Carneiro ◽  
Janice Mendes Stuart ◽  
Jorge Patrick Oliveira Feliciano ◽  
Daniella Cristina Nassau
Keyword(s):  
Septic Shock ◽  
Histoplasma Capsulatum ◽  
Peripheral Blood Smear ◽  
The Body ◽  
Rapid Progression ◽  
Newly Diagnosed ◽  
Systemic Mycosis ◽  
Disseminated Histoplasmosis ◽  
Serious Infection ◽  
History Of

SUMMARY Histoplasmosis is a systemic mycosis caused by Histoplasma capsulatum, which may present itself as a serious infection in immunocompromised individuals. We present a case of 31-year-old female with newly diagnosed HIV infection and history of fever, general and respiratory symptoms and diffuse hyperchromic papules through the body. She was admitted, with rapid progression to septic shock, and the presence of neutrophils filled with yeast-like organisms was detected on peripheral blood smear hematoscopia on the third day of hospitalization. The following is a brief review on the clinical picture and management of histoplasmosis.

Biliary Dilation: An Unusual Presentation of Histoplasma capsulatum in a Dog

2020 ◽  
Vol 56 (5) ◽  
pp. 285
Author(s):  
Harry Cridge ◽  
Erin Brinkman ◽  
Patty Lathan
Keyword(s):  
Histoplasma Capsulatum ◽  
Abdominal Distension ◽  
Abdominal Ultrasound ◽  
Biliary Duct ◽  
Potential Complication ◽  
Intact Male ◽  
Fine Needle ◽  
Fine Needle Aspirates ◽  
Disseminated Histoplasmosis ◽  
History Of

ABSTRACT A 4 mo old intact male Labrador retriever was referred to the authors’ institution for a 3 wk history of weight loss and progressive abdominal distension. Thoracic radiographs revealed sternal lymphadenopathy and a diffuse unstructured interstitial and bronchial pulmonary pattern. An abdominal ultrasound revealed multifocal lymphadenopathy, hepatosplenomegaly, and biliary duct dilation. Fine-needle aspirates of the spleen and liver revealed Histoplasma capsulatum organisms. Antifungal therapy was initiated with itraconazole and terbinafine. Repeat ultrasound examinations revealed resolving hepatosplenomegaly and resolving cystic duct dilation. Ultrasonographic findings mirrored a decrease in urine H capsulatum antigen levels. Histoplasmosis should be considered as a differential for unexplained biliary duct dilation or obstruction in dogs. Dogs with disseminated histoplasmosis should be monitored for this potential complication.

scholarly journals Disseminated Histoplasmosis with Miliary Histoplasmosis, Neurohistoplasmosis, and Histoplasma capsulatum Bacteremia in Probable Neurosarcoidosis

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Peter V. Bui
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Histoplasma Capsulatum ◽  
Fungal Infections ◽  
Immunosuppressive Agents ◽  
Barrier Dysfunction ◽  
Diagnostic Uncertainty ◽  
Disseminated Histoplasmosis ◽  
History Of ◽  
The Central Nervous System

Introduction. Neurosarcoidosis, either isolated or as part of systemic sarcoidosis, is an uncommon entity and has diagnostic uncertainty. Treatment for neurosarcoidosis can increase the risk of infections, including fungal infections such as disseminated histoplasmosis. Neurosarcoidosis may further predispose patients to infections of the central nervous system. Case Presentation. A 54-year-old male with a history of probable neurosarcoidosis on methotrexate and infliximab presented with encephalopathy, hypoxia, and reported fevers. The patient was found to have disseminated histoplasmosis involving the lungs (miliary histoplasmosis), central nervous system (neurohistoplasmosis), and bloodstream. The Histoplasma capsulatum infection was treated with amphotericin and then voriconazole. Discussion. Patients with neurosarcoidosis are suspected to have blood-brain barrier dysfunction. Lumbar puncture should be considered as part of initial investigative studies for infection. Empiric antimicrobial therapy for a patient with neurosarcoidosis on immunosuppressive agents may need to include antifungal agents.

A case of oral ulceration and disseminated histoplasmosis in HIV infection

2012 ◽  
Vol 23 (7) ◽  
pp. 522-523 ◽  
Author(s):  
D Sharma ◽  
A Mckendry ◽  
S Nageshwaran ◽  
J Cartledge
Keyword(s):  
Lymph Node ◽  
Hiv Infection ◽  
Hiv Testing ◽  
Respiratory Symptoms ◽  
Histoplasma Capsulatum ◽  
Cd4 Count ◽  
Unusual Presentation ◽  
Oral Ulceration ◽  
Disseminated Histoplasmosis ◽  
History Of

A 51-year-old Malawian woman presented with persistent mouth ulceration and an eight-month history of non-specific respiratory symptoms. Histoplasma capsulatum was diagnosed on gum, gastric and lymph node biopsies. Identification of H. capsulatum prompted HIV testing and the patient tested positive with a CD4 count of 40 cells/mm3. The diagnosis of histoplasmosis was delayed due to its unusual presentation.

scholarly journals Disseminated Histoplasmosis

1970 ◽  
Vol 11 (1) ◽  
pp. 70-73 ◽  
Author(s):  
Md Shahriar Mahbub ◽  
HAM Nazmul Ahasan ◽  
Md Titu Miah ◽  
Md Billal Alam ◽  
Ratan Das Gupta ◽  
...  
Keyword(s):  
Histoplasma Capsulatum ◽  
Bone Marrow Aspirate ◽  
Shortness Of Breath ◽  
Healthy Male ◽  
Disseminated Histoplasmosis ◽  
Level Of Consciousness ◽  
History Of ◽  
Endemic Mycoses ◽  
Physical Findings ◽  
Apparently Healthy

A case of disseminated histoplasmosis in a 56-year-old apparently healthy male without any history of travel to endemic zone is described. The patient presented with fever with cough, respiratory distress and disorientation. Physical findings include fever, shortness of breath, reduced level of consciousness and hypotension. Diagnosis was confirmed by presence of Histoplasma capsulatum in bone marrow aspirate. This report illustrates the importance of recognizing the possibility of histoplasmosis in Bangladesh where mimickers of histoplasmosis like pulmonary tuberculosis and visceral leishmaniasis are extremely common. Keywords: Histoplasmosis, endemic mycoses, disseminated histoplasmosis, Histoplasma capsulatum, Bangladesh DOI:10.3329/jom.v11i1.4278 J Medicine 2010: 11: 70-73

scholarly journals Utility of antigen testing for the diagnosis of ocular histoplasmosis in four cats: a case series and literature review

2016 ◽  
Vol 19 (10) ◽  
pp. 1110-1118 ◽  
Author(s):  
Kathryn M Smith ◽  
Ann R Strom ◽  
Margi A Gilmour ◽  
Elise LaDouceur ◽  
Christopher M Reilly ◽  
...  
Keyword(s):  
Antifungal Therapy ◽  
Histoplasma Capsulatum ◽  
Case Series ◽  
Subretinal Fluid ◽  
Ocular Tissues ◽  
Urine Antigen ◽  
Potential Difficulty ◽  
Antigen Tests ◽  
Antigen Testing ◽  
Systemic Antifungal Therapy

Case series summary This case series describes the clinical utility of antigen testing for the diagnosis of feline ocular histoplasmosis. Four cats with suspected (n = 2) or confirmed (n = 2) ocular histoplasmosis are described: three from Oklahoma and one from California. In one case, serial urine antigen tests, as well as a serum antigen test for Histoplasma capsulatum, were negative; however, light microscopy identified microorganisms consistent with H capsulatum in ocular tissues at necropsy. In a further two cats with recurrent ocular histoplasmosis following long-term systemic antifungal therapy, Histoplasma species urine antigen concentrations were negative, but both cats improved clinically following systemic antifungal therapy and remained in apparent clinical remission after treatment cessation (9–16 months). The final cat displayed profound bilateral endophthalmitis; however, Histoplasma species antigen testing of vitreous humor and subretinal fluid from the left eye was negative. Intralesional organisms were detected on histopathology of both eyes, and H capsulatum was subsequently isolated and sequenced from tissue of one eye. Relevance and novel information These cases highlight the potential difficulty in definitively diagnosing ocular histoplasmosis in cats when conducting antigen testing of serum, urine and even ocular fluids. Although antigen testing has previously proven useful in the diagnosis of disseminated feline histoplasmosis, it may not be adequate in cats with only ocular signs.

scholarly journals Progressive disseminated histoplasmosis in idiopathic CD4 lymphocytopenia an underdiagnosed combination - a case report

2021 ◽  
Author(s):  
Prakrati Yadav ◽  
Deepak Kumar ◽  
Gopal Krishana Bohra ◽  
Mahendra Kumar Garg ◽  
Jyotsna N Bharti ◽  
...  
Keyword(s):  
Liposomal Amphotericin ◽  
Significant Weight Loss ◽  
Cd4 Counts ◽  
Disseminated Histoplasmosis ◽  
History Of ◽  
Progressive Disseminated Histoplasmosis ◽  
Her 2 ◽  
Idiopathic Cd4 Lymphocytopenia ◽  
Hiv Negative ◽  
Rule Out

Progressive disseminated histoplasmosis (PDH) usually presents as fever, anemia, leukopenia, hepatosplenomegaly, lymphadenopathy and pulmonary symptoms. There are few reports showed the association of Idiopathic CD4 lymphocytopenia (ICL) with histoplasmosis. We describe a 65-year-old female presented with history of fever, papulo-nodular rash and significant weight loss and diagnosed as progressive disseminated histoplasmosis. All immunocompromised conditions were ruled out.  In addition, her 2 consecutive CD4 counts were below 300. The patient was diagnosed with PDH associated with ICL. Patient showed significant improvement with liposomal amphotericin B and itraconazole. Absolute CD4 counts should be done in all cases of progressive disseminated histoplasmosis even in HIV negative individuals to rule out associated ICL.

CAT SCRATCH SYNDROME

PEDIATRICS ◽  
1952 ◽  
Vol 10 (3) ◽  
pp. 311-318
Author(s):  
WILLIAM J. WATERS ◽  
SEYMOUR S. KALTER ◽  
JOHN T. PRIOR
Keyword(s):  
Skin Test ◽  
Laboratory Tests ◽  
Complement Fixation Test ◽  
Complement Fixation ◽  
Clinical Laboratory ◽  
Clinical Course ◽  
Diagnostic Value ◽  
Clinical Findings ◽  
Pathologic Findings ◽  
History Of

The clinical, laboratory and pathologic findings of a series of cases of cat scratch syndrome have been reviewed. In spite of a variable clinical course, certain features associated with a selected group of laboratory tests appear to be constant enough to be of diagnostic value. A history of contact with a cat and/or scratch which is usually associated with a peripheral skin lesion, lack of lymphangitis, presence of regional lymphadenopathy with tenderness to palpation are the most constant clinical findings. Fever, so frequently emphasized as a characteristic clinical sign, may be extremely variable in type and duration or entirely absent. A skin test with cat scratch antigen has been positive in all cases. Lacking this antigen, a negative Frei skin test in conjunction with a positive complement fixation test (Lygranum C. F.) is suggestive evidence for the diagnosis. With positive evidence from the above data, biopsy of an affected gland with its relatively nonspecific pathologic picture is not considered essential for the establishment of the diagnosis of cat scratch syndrome.

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