Disseminated histoplasmosis with reactive hemophagocytosis: Aspiration cytology findings in two cases

Abstract

Two cases of disseminated histoplasmosis associated with reactive hemophagocytic syndrome are described. The clinical presentation was with prolonged unexplained fever and hepatosplenomegaly. On a strong clinical possibility of tuberculosis, antitubercular treatment was initiated in both patients. Lymph node (case 1), splenic (case 2), and bone marrow aspiration, however, showed sheets of proliferating histiocytes, and intracellular and extracellular histoplasma organisms. Aspiration cytology was thus valuable in establishing the final diagnosis. The patients had a fulminant clinical course and died of hemorrhagic shock within 48 hr of hospital admission before specific therapy could be initiated. Histoplasmosis can mimic tuberculosis clinically. There is a need for an increased awareness of the clinicopathological spectrum of histoplasmosis, especially its rarer manifestations as hemophagocytic syndrome. In suspected cases, aspirations from the lymph node, liver, and spleen can be performed safely and should be utilized for early diagnosis. Diagn. Cytopathol. 2000;23:422–424. © 2000 Wiley‐Liss, Inc.

Fever of Unknown Origin in Taiwan

“…Disseminated tuberculosis and histoplasmosis may cause hemophagocytosis with fever of unknown origin [21,22]. In our series, four patients with FUO also had hemophagocytotic syndrome.…”

Expanding the horizons of histoplasmosis: disseminated histoplasmosis in a renal transplant patient after a trip to Bangladesh

“…Subramanian et al (9) report 18 additional cases diagnosed in India. Review of the literature revealed 51 more cases in India, 3 probable cases, 1 unpublished case mentioned in a review, and 2 cases from personal communications (13–48). Thirteen cases have been diagnosed in the United Kingdom in patients with prior residence on the Indian subcontinent (10), and 1 case was diagnosed in Canada in a patient who had recently traveled to India (49).…”

Leukoerythrophagocytosis by sinus histiocytes: Case report

“…1 It is also observed in hairy cell leukemia, Hodgkin's disease, certain types of acute leukemia, and certain high-grade epithelial malignancies. 2 Reactive hemophagocytosis associated with disseminated histoplasmosis has been reported in the aspiration cytology of spleen and lymph nodes by Kumar et al 3 Association of reactive hemophagocytosis with tuberculosis has not been reported to our knowledge.…”