Prostatic and Central Nervous System Histoplasmosis in an Immunocompetent Host: Case Report and Review of the Prostatic Histoplasmosis Literature

Abstract

Histoplasmosis is a common cause of systemic mycosis in areas of the United States where it is endemic. Central nervous system and genitourinary histoplasmosis is rare, especially in immunocompetent hosts. We describe a case of disseminated histoplasmosis in a normal host that was associated with cerebral and prostatic histoplasmosis presenting as fever of undetermined origin, weight loss, and severe debilitating altered mental status. The patient subsequently developed acute renal failure that manifested as obstructive uropathy during antifungal therapy with amphotericin B. Transurethral resection of the prostate resulted in improved renal function during continuation of amphotericin B therapy. Pathological analysis of the prostate revealed necrotizing granulomas with intralesional fungal organisms. Blood and urine cultures were positive for Histoplasma capsulatum. Diagnostic issues and management are discussed. Treatment resulted in return of normal cognitive and motor function. This case is compared with the 8 previously reported cases of H. capsulatum prostatitis.

Diagnosis and Management of Central Nervous System Histoplasmosis

“…Itraconazole does not penetrate the CSF, but was effective in an experimental model of Histoplasma meningitis [32]. There are also reports of success [14,21,23,25,26] and failure [2,24] in using itraconazole for treatment of Histoplasma meningitis in patients. A summary of outcomes of triazole therapy for CNS histoplasmoma is shown in table 4.…”

Histoplasmosis: a Clinical and Laboratory Update

“…For example, genitourinary tract involvement, although frequently documented at autopsy in patients with disseminated infection (64,97), is rarely symptomatic. Testicular abscess, prostatic abscess, epididymitis, penile lesions, and bladder ulcerations have been reported for a few patients each (38,65,84,112). The patients are often thought to have a tumor of the prostate, testes, or epididymis until a biopsy specimen reveals the typical yeast-like forms of H. capsulatum.…”

Acute Disseminated Histoplasmosis with Atypical Lymphocytosis in an Immunocompetent Host

“…Reactivation with dissemination may occur in ∼5% of cases and occurs mostly in immunocompromised and patients at extremes of age [1]. Genitourinary involvement with H. capsulatum is uncommon with only a few case reports of prostate involvement described in patients with human immunodeficiency virus infection (HIV) [2]. We describe an unusual presentation of acute disseminated histoplasmosis following cystoscopy in an immunocompetent patient.…”