AIDS-related disseminated histoplasmosis (DH) can cause septic shock and
multiorgan dysfunction with mortality rates of up to 80%. A 41-year-old male
presented with fever, fatigue, weight loss, disseminated skin lesions, low urine
output, and mental confusion. Three weeks before admission, the patient was
diagnosed with HIV infection, but antiretroviral therapy (ART) was not
initiated. On day 1 of admission, sepsis with multiorgan dysfunction (acute
renal failure, metabolic acidosis, hepatic failure, and coagulopathy) was
identified. A chest computed tomography showed unspecific findings. Yeasts
suggestive of
Histoplasma spp.
were observed in a routine
peripheral blood smear. On day 2, the patient was transferred to the ICU, where
his clinical condition progressed with reduced level of consciousness,
hyperferritinemia, and refractory septic shock, requiring high doses of
vasopressors, corticosteroids, mechanical ventilation, and hemodialysis.
Amphotericin B deoxycholate was initiated. On day 3, yeasts suggestive of
Histoplasma spp.
were observed in the bone marrow. On day
10, ART was initiated. On day 28, samples of peripheral blood and bone marrow
cultures revealed
Histoplasma spp.
The patient stayed in the
ICU for 32 days, completing three weeks of intravenous antifungal therapy. After
progressive clinical and laboratory improvement, the patient was discharged from
the hospital on oral itraconazole, trimethoprim-sulfamethoxazole, and ART. This
case highlights the inclusion of DH in the differential diagnosis of patients
with advanced HIV disease, septic shock and multiorgan dysfunction but without
respiratory failure. In addition, it provides early in-hospital diagnosis and
treatment and comprehensive management in the ICU as determining factors for a
good outcome.