Acute Disseminated Histoplasmosis with Atypical Lymphocytosis in an Immunocompetent Host

Abstract

65 year-old-male presented with a one-week history of high grade fever, fatigue and confusion which began abruptly two days after a cystoscopy procedure. Past medical history included pulmonary sarcoidosis diagnosed by mediastinal lymph biopsy, diabetes and hypertension. On admission he was febrile and confused with stable vital signs. Initial workup included negative Head CT and lumbar puncture. Blood work revealed normal metabolic and liver function tests with progressive anemia, thrombocytopenia and atypical lymphocytosis of 15–20%. Blood, urine and respiratory cultures all were negative for bacteria and. A bone marrow biopsy was done given the abnormal lymphocytes in peripheral smear, revealing budding yeast consistent with Histoplasma capsulatum. Histoplasma antigen was positive in urine and eventually blood and bone marrow grew H. capsulatum. Patient was started on amphotericin-B for diagnosis of disseminated histoplasmosis. After a 2 week period of amphotericin B, patient was switched to oral Itraconazole to complete 12 months course of treatment.

Thrombocytopenia and disseminated histoplasmosis in immunocompetent adults

“…The 13 articles fulfilling inclusion criteria are summarized in Table 1. In total, 45 cases of histoplasmosis and thrombocytopenia have been reported in immunocompetent adults since 1950, including 21 from Vanderbilt University Medical Center [5], 10 from the Christian Medical College in India [7], four from the National Institutes of Health Clinical Center [8], and 10 reports of individual cases [3,4,6,[9][10][11][12][13][14][15]. Among these reports, demographics and case details were provided for 14 patients; ages ranged from 20 to 77 years (mean of 52), 11 patients (79%) were male, nine (64%) had splenomegaly, and four (29%) died from active histoplasmosis.…”