Escher M, Kainikkara T M, Grabner A, Ott G, Stange E F, Herrlinger K R
Gastroenterologie, Hepatologie und Endokrinologie, Innere Medizin I, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
Dtsch Med Wochenschr. 2012 Feb;137(6):260-4. doi: 10.1055/s-0031-1298872. Epub 2012 Jan 31.
A 19-year-old HIV-positive man was admitted with fever of unknown origin and poor general condition. Antiretroviral therapy had been stopped by the patient eight months prior to admission.
Laboratory tests revealed pancytopenia, high viral load and low count of T-helper cells (13/µl). Computer tomography of the thorax showed small patchy infiltrations. Extensive examinations (microbiology, laboratory tests, multiple investigations) revealed no pathogen. Liver biopsy proved disseminated histoplasmosis.
Liposomal amphotericin B was started and switched to oral itraconazole after 14 days with itraconazole. With this treatment the patient condition improved and fever stopped. T-helper cells increased and the patient was discharged.
Disseminated histoplasmosis as an AIDS-defining opportunistic infection is uncommon (particularly as the patient had not been abroad in the last four years) and can be a life-threatening complication. Diagnosis must be confirmed by invasive methods especially in patients with compromised immune status and rapid clinical progression.
