Pipitò Luca, Medaglia Alice Annalisa, Trizzino Marcello, Mancuso Alessandro, Catania Bianca, Mancuso Salvatrice, Calà Cinzia, Florena Ada Maria, Cascio Antonio
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro," University of Palermo, Palermo, Italy.
Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the Fight Against AIDS, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy.
Heliyon. 2023 Jul 21;9(8):e18537. doi: 10.1016/j.heliyon.2023.e18537. eCollection 2023 Aug.
Here, we describe the case of a naïve HIV late presenter female African patient with progressive disseminated histoplasmosis and a severe life-threatening clinical picture in a non-endemic area. She had not visited Africa in the past decade. She developed a reactive hemophagocytic lymphohistiocytosis and an acute psychiatric disorder. Histoplasmosis was diagnosed after two bone marrow biopsies. Therapy with liposomal amphotericin B resulted in rapid and progressive improvements in blood examinations and clinical conditions, including the disappearance of psychiatric disorders. The characteristics of our case were compared with those of all other cases of hemophagocytic syndrome secondary to histoplasmosis in HIV-positive patients reported in PubMed. In conclusion, clinicians outside endemic areas should evaluate histoplasmosis as a cause of severe clinical picture, especially in a patient with a travel history to an endemic area, even after many years, considering the possible reactivation of latent infection.
在此，我们描述了一例未接受过治疗的晚期就诊的非洲女性HIV患者的病例，该患者在非流行地区患有进行性播散性组织胞浆菌病，临床症状严重，危及生命。她在过去十年中未去过非洲。她出现了反应性噬血细胞性淋巴组织细胞增生症和急性精神障碍。经过两次骨髓活检后诊断为组织胞浆菌病。脂质体两性霉素B治疗使血液检查和临床状况迅速且逐步改善，包括精神障碍消失。我们将该病例的特征与PubMed报道的所有其他HIV阳性患者继发于组织胞浆菌病的噬血细胞综合征病例的特征进行了比较。总之，非流行地区的临床医生应将组织胞浆菌病评估为严重临床症状的病因，特别是对于有前往流行地区旅行史的患者，即使是多年后，也要考虑潜伏感染可能重新激活的情况。
