Kerego Yemesrach, Gouzi Lidiya Didenko, Doobay Padmani
Department of Research and Innovation, St. L St. Luke's University Health Network, Bethlehem, PA, USA.
Department of Family Medicine, St. Luke's University Health Network, Warren, NJ, USA.
Radiol Case Rep. 2024 Oct 19;20(1):177-181. doi: 10.1016/j.radcr.2024.09.134. eCollection 2025 Jan.
Disseminated histoplasmosis is a rare yet serious fungal infection that primarily affects individuals with compromised immune systems. While it is widely known for its endemicity in the Midwest region of the USA, recent studies have indicated a noteworthy increase in sporadic cases, suggesting a widening of the endemic region for the pathology. This report describes a case of disseminated histoplasmosis in a 39-year-old female with a history of lupus, hypertension, anxiety, asthma, idiopathic edema, and fibromyalgia from a nonendemic region, who presented with cyclic fevers of unknown origin, peripheral edema, and oral sores. On admission, she was diagnosed with acute pyelonephritis and started on levofloxacin. She continued to develop worsening leukopenia and thrombocytopenia in addition to bone and joint pain. Bone marrow biopsy results were consistent with hemophagocytic lymphohistiocytosis (HLH) triggered by histoplasmosis confirmed by PCR. Despite an initial negative urine antigen test for Histoplasma, subsequent tests showed rising levels. The patient's clinical course was marked by a protracted hospital stay, multiple systems involvement, severe de-conditioning, drug side effects requiring adjustments in anti-fungal medications, and interdisciplinary care. The patient gradually improved and was discharged home with follow-ups. This study underscores the role of timely diagnosis of disseminated histoplasmosis in patients with underlying autoimmune diseases for favorable outcomes, thereby emphasizing the necessity of heightened clinical suspicion. By addressing the nuanced challenges that arise in managing multiple complications in the domain of disseminated histoplasmosis, advocates a comprehensive interdisciplinary approach to optimize patient care.
播散性组织胞浆菌病是一种罕见但严重的真菌感染，主要影响免疫系统受损的个体。虽然它在美国中西部地区的地方性流行广为人知，但最近的研究表明散发病例有显著增加，这表明该病理的流行区域正在扩大。本报告描述了一例来自非流行地区的39岁女性播散性组织胞浆菌病病例，该女性有狼疮、高血压、焦虑症、哮喘、特发性水肿和纤维肌痛病史，表现为不明原因的周期性发热、外周水肿和口腔溃疡。入院时，她被诊断为急性肾盂肾炎并开始使用左氧氟沙星治疗。除了骨和关节疼痛外，她还持续出现白细胞减少和血小板减少加重的情况。骨髓活检结果与组织胞浆菌病引发的噬血细胞性淋巴组织细胞增生症（HLH）一致，PCR检测证实了这一点。尽管最初的组织胞浆菌尿抗原检测呈阴性，但随后的检测显示水平不断上升。患者的临床病程特点是住院时间延长、多系统受累、严重失能、药物副作用需要调整抗真菌药物以及跨学科护理。患者逐渐好转并出院接受随访。本研究强调了及时诊断潜在自身免疫性疾病患者的播散性组织胞浆菌病对于取得良好预后的作用，从而强调了提高临床怀疑度的必要性。通过应对播散性组织胞浆菌病领域中管理多种并发症时出现的细微挑战，提倡采用全面的跨学科方法来优化患者护理。
