Matheus Fellipe Nascimento de Souza
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Ana Paula Teixeira da Silva
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Gabriela Santos Bianchin
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Maria Eduarda Angelo de Mendonça Fileti
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Raddib Eduardo Noleto da Nóbrega de Oliveira
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Context: Histoplasmosis (Histoplasma capsulatum) is a systemic disease that affects the lung and immune system1. The severity of histoplasmosis is directly related to the individual’s immune response since it is an opportunistic pathogen2. It is one of the most prevalent infections in immunocompromised patients due to the use of tumor necrosis factor-alpha (TNF-alpha) inhibitors, resulting in a mortality rate of 20%. The evolution to CNS occurs in 5-10% of patients with disseminated symptoms3. Case Report: M.G.M, a woman, 67 years, was admitted with bilateral tonicclonic seizure with focal onset in the right upper limb. The patient had hypertension, diabetes and rheumatoid arthritis, and was use ASA, glibenclamide, hydrochlorothiazide, losartan, amlodipine, adalimumab and methotrexate. Complementary exams were performed that showed lesions suggestive of microangiopathy on cranial CT; nodular lesions in the pulmonary right upper lobe and prominent lymph nodes in the hilum and mediastinum on chest CT; CSF with increased cytology (monomorphonuclear predominance), without glucose consumption. The biopsy of lung lesions identified Histoplasma capsulatum, confirming the diagnosis of progressive disseminated histoplasmosis with pulmonary and CNS involvement. Thus, treatment with amphotericin B was started, however, the patient died. Conclusions: Histoplasmosis is the most prevalent invasive fungal infection in users of TNF-alpha inhibitors. In these cases, the disease can be more aggressive and have a rapid evolution, with CNS involvement - which confers a worse prognosis. Early diagnosis, suspension of the immunomodulator and adequate treatment for infection control are required.
Progressive Disseminated Histoplasmosis Mimicking as Anal Carcinoma – Look at the Mountain, Not at Stone: A Case Report
