Histoplasma capsulatumInfection with Extensive Lytic Bone Lesions Mimicking LCH

Abstract

Multiple lytic bone lesions in a child can be a manifestation of various diseases like Langerhans cell histiocytosis, metastatic neuroblastoma, leukemia, hyperparathyroidism, multifocal osteomyelitis and histoplasmosis. Disseminated histoplasmosis caused by Histoplasma capsulatum var. duboisii is well known to present with multiple osteolytic lesions in immunocompromised adults and is mostly restricted to the African subcontinent. Histoplasmosis seen in American and Asian countries is caused by Histoplasma capsulatum var. capsulatum, which presents with pulmonary and systemic manifestations and rarely bone involvement. We report a case of histoplasmosis, caused by H. capsulatum var. capsulatum with extensive lytic bone lesions in a 13 year old immunocompetent boy who presented with prolonged fever, weight loss and multiple boggy swellings. He responded to amphotericin and is currently on Itraconazole. This case is unique for extensive osteolytic lesions with H. capsulatum var. capsulatum infection in an immunocompetent child.

Disseminated histoplasmosis presenting as pyoderma gangrenosum‐like ulcers in an apparently immunocompetent patient: multiple red herrings presenting a diagnostic challenge

“…Bone involvement is also extremely rare, manifesting as carpal tunnel syndrome, septic arthritis, or osteomyelitis. There are only a few reports of osteolytic lesions mimicking malignancy, as in our case 5,6 . Gastrointestinal involvement, reported to occur in 70–90% of patients in autopsy studies, is symptomatic in only 3–12% of cases and shows nonspecific findings on colonoscopy 7 .…”

Prosthetic Joint Infections Due to Histoplasma capsulatum: A Report of 3 Cases

“…11 As mentioned, bone and joint infections due to H capsulatum are rare. 3,12 None of the fungal PJIs in our institution from 1996 to 2014 were due to H capsulatum. 11 In a review of 222 osteoarticular infections due to dimorphic fungi from 1970 to 2012, only 18 cases of H capsulatum were observed.…”

A Child with Chronic Fungal Infection in Bangladesh that Mimicked Malignancy: Disseminated Histoplasmosis

“…16 In the northeastern India, a 13-year-old immunocompetent child presented with florid bone involvement with Histoplasma capsulatum, who had chronic exposure to pigeon droppings. 17 Our patient was from sub-urban areas of Bangladesh, where there is adequate exposure to soil containing birds and bat excreta. As histoplasmosis is not very common in this part of the world, his diagnosis was much delayed.…”