Case of disseminated histoplasmosis in a HIV-infected patient revealed by nasal involvement with maxillary osteolysis

Abstract

BackgroundDisseminated Histoplasmosis (DH) is a rare manifestation of Acquired Immune Deficiency Syndrome (AIDS) in European countries. Naso-maxillar osteolysis due to Histoplasma capsulatum var. capsulatum (Hcc) is unusual in endemic countries and has never been reported in European countries. Differential diagnoses such as malignant tumors, cocaine use, granulomatosis, vasculitis and infections are more frequently observed and could delay and/or bias the final diagnosis.Case presentationWe report the case of an immunocompromised patient infected by Human Immunodeficiency Virus (HIV) with naso-maxillar histoplasmosis in a non-endemic country. Our aim is to describe the clinical presentation, the diagnostic and therapeutic issues. A 53-year-old woman, originated from Haiti, was admitted in 2016 for nasal deformation with alteration of general condition evolving for at least 6 months. HIV infection was diagnosed in 2006 and classified at AIDS stage in 2008 due to cytomegalovirus infection associated with pulmonary histoplasmosis. At admission, CD4 cell count was 9/mm3. Surgical biopsies were performed and ruled out differential or associated diagnoses. Mycological cultures identified Hcc and Blood Polymerase Chain Reaction (PCR) for Hcc was positive. The patient was given daily Amphothericin B liposomal infusion during 1 month. Hcc PCR became negative in the blood under treatment, and then oral switch by itraconazole was introduced. Antiretroviral treatment was reintroduced after a 3-week histoplasmosis treatment. Normalization of naso-maxillar mucosa enabled a palatal prosthesis.ConclusionNaso-maxillar histoplasmosis is extremely rare; this is the first case ever reported in a non-endemic country. Differential diagnoses must be ruled out by conducting microbiologic tools and histological examinations on surgical biopsies. Early antifungal treatment should be initiated in order to prevent DH severe outcomes.

Nasal Septum Perforation Associated to Histoplasmosis: A Retrospective Study

“…Pulmonary manifestations were registered in six cases whit abnormal chest X-ray. These findings are similar to what is described in the literature [12,[24][25][26][27][28][29][30].…”

“…Almost all studies in the international literature, report NSP in patients with HIV/AIDS. A recent case report and literature review showed a Haitian female with HIV/AIDS and nasal septum destruction along with another 18 cases, almost all have HIV/AIDS [25]. The same data has been reported elsewhere [26,28,29].…”

Histoplasmosis Diagnosed in Europe and Israel: A Case Report and Systematic Review of the Literature from 2005 to 2020

“…Although a search for serum and urinary Histoplasma antigen is considered a very sensitive and rapid means of diagnosing histoplasmosis, it was used in none of the PLWH and only two of the patients with OIC [73,74], but in five immunocompetent patients (6.1%) [103,124,136]. In order to overcome the very limited availability of the Histoplasma antigen in most European laboratories, galactomannan (GM) antigen is used as a surrogate marker of infection on the grounds of its cross-reactivity with Histoplasma capsulatum antigen [159] and was positive in 87.5% of the PLWH ( [36,47,51,53,57,60,64] and PR) and 75% of the patients with OIC [77,79,82,84] who had disseminated histoplasmosis. The use of PCR was reported in 33.2% of the patients as a whole: 46/114 PLWH (40.3%) (Table 2) and 11/28 patients with OIC (39.3%) (Table 4).…”

“…was directly visualised on peripheral blood smears of eight patients [19,30,40,41,45,55,62,65,66]. The use of serum galactomannan (GM) antigen was reported in eight cases ( [36,47,51,53,57,60,64] and Present Report) and was positive in seven (87.5%) with a median OD index of 2.23; urinary or serum Histoplasma antigen was not sought in any of the cases. The most frequently identified species was Histoplasma capsulatum (79/113 cases, 69.9%); 17.7% of the cases were attributed to H. duboisii.…”

Nasal septum ulcer as an isolated manifestation of histoplasmosis

“…It is estimated that the disseminated form is related to HIV infection in 70–90% of cases in countries where the disease is endemic. Isolated lesions of mucous membranes are infrequent [1].…”