An Unusual Presentation of Disseminated Histoplasmosis: Case Report and Review of Pediatric Immunocompetent Patients from India

Agarwal, Poojan; Capoor, Malini R.; Singh, Mukul; Gupta, Arpita; Chhakchhuak, Arini; Debatta, Pradeep

doi:10.1007/s11046-015-9917-y

Cited by 7 publications

(6 citation statements)

References 10 publications

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“…Pulmonary symptoms at presentation or during the disease course were not reported in any case. Five patients were presumed immunocompetent[ 20 - 22 ], while two patients were known to have immunocompromising conditions (hyper-IgE syndrome) prior to their presentation[ 18 , 19 ]. One patient with hyper-IgE syndrome was effectively treated seven months prior for cough and fever of unknown origin[ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal histoplasmosis complicating pediatric Crohn disease: A case report and review of literature

Miller¹,

Saeed²,

Collins³

2022

World J Gastrointest Endosc

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BACKGROUND Infection with Histoplasma capsulatum ( H. capsulatum ) can lead to disseminated disease involving the gastrointestinal tract presenting as diffuse abdominal pain and diarrhea which may mimic inflammatory bowel disease (IBD). CASE SUMMARY We report a case of 12-year-old boy with presumptive diagnosis of Crohn disease (CD) that presented with several months of abdominal pain, weight loss and bloody diarrhea. Colonoscopy showed patchy moderate inflammation characterized by erythema and numerous pseudopolyps involving the terminal ileum, cecum, and ascending colon. Histologic sections from the colon biopsy revealed diffuse cellular infiltrate within the lamina propria with scattered histiocytic aggregates, and occasional non-necrotizing granulomas. Grocott-Gomori’s Methenamine Silver staining confirmed the presence of numerous yeast forms suggestive of Histoplasma spp., further confirmed with positive urine Histoplasma antigen (6.58 ng/mL, range 0.2-20 ng/mL) and serum immunoglobulin G antibodies to Histoplasma (35.9 EU, range 10.0-80.0 EU). Intravenous amphotericin was administered then transitioned to oral itraconazole. Follow-up computed tomography imaging showed a left lower lung nodule and mesenteric lymphadenopathy consistent with disseminated histoplasmosis infection. CONCLUSION Gastrointestinal involvement with H. capsulatum with no accompanying respiratory symptoms is exceedingly rare and recognition is often delayed due to the overlapping clinical manifestations of IBD. This case illustrates the importance of excluding infectious etiologies in patients with “biopsy-proven” CD prior to initiating immunosuppressive therapies. Communication between clinicians and pathologists is crucial as blood cultures and antigen testing are key studies that should be performed in all suspected cases of histoplasmosis to avoid misdiagnosis and inappropriate treatment.

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Section: Discussionmentioning

confidence: 99%

Gastrointestinal histoplasmosis complicating pediatric Crohn disease: A case report and review of literature

Miller¹,

Saeed²,

Collins³

2022

World J Gastrointest Endosc

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“…Según Agarwal et al, la evaluación de los laboratorios frecuentemente revela pancitopenia, causada por la participación de la médula ósea y los resultados anormales en las pruebas de función hepática, indican diseminación al hígado. 17 Llama la atención en nuestra institución que a pesar de las formas avanzadas de la enfermedad e inicio tardío de la terapia solo se logró aislar el histoplasma en un solo paciente. Esto contrasta con el estudio observacional realizado en Colombia por López et al, se encontró una importante relación entre manifestaciones sistémicas y participación de la médula ósea en lactantes y su aislamiento.…”

Section: Discussionunclassified

“…5 En cuanto a las manifestaciones clínicas, la mayoría de las infecciones son autolimitadas, cuando hay síntomas son generalmente inespecíficos e incluyen fiebre, tos, y malestar general. 6 Los pacientes sintomáticos a menudo se presentan con manifestaciones respiratorias, opacidades pulmonares, linfadenopatía hiliar, y probablemente organomegalia. 1 Las formas de presentación varían según el huésped, calidad del sistema inmune y la virulencia de patógeno.…”

Section: Introductionunclassified

Características clínicas, epidemiológicas, diagnóstico y tratamiento de los pacientes pediátricos con histoplasmosis en el Hospital Materno infantil José Domingo de Obaldía, desde enero 2008 a diciembre 2018

2020

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Introducción: La histoplasmosis es una enfermedad causada por el hongo Histoplasma capsulatum, descrita por primera vez por Samuel Taylor Darling en un trabajador de la zona del canal de Panamá. La exposición al hongo es frecuente en áreas tropicales y subtropicales, la mayoría son infecciones asintomáticas o ligeramente sintomáticas Los pacientes pediátricos son más vulnerables a padecer formas graves de histoplasmosis, especialmente menores de dos años. Materiales y métodos: Se realizó un estudio transversal retrospectivo, en pacientes diagnosticados con histoplasmosis en el Hospital Materno Infantil José Domingo de Obaldía de enero de 2008 a diciembre 2018. Resultados: Se analizaron 8 casos en 11 años (2008-2018), El principal grupo afectado fueron los menores de 2 años (n=7). Las características clínicas encontradas fueron: hepatomegalia y esplenomegalia en todos los pacientes, además, fiebre, adenopatías, anorexia, y astenia Se encontró trombocitopenia en todos los casos, seguido de anemia y leucopenia; e infiltrado alveolo intersticial en la radiografía de tórax de 6 pacientes. No se encontraron pacientes con infección por VIH. El método diagnóstico fue a través de estudios histopatológicos en el aspirado de médula ósea. El tratamiento utilizado fue anfotericina B, seguido de Itraconazol. De los 8 pacientes, 6 fallecieron con una letalidad del 75%. Conclusiones: Es una entidad poco frecuente en nuestra institución. Tiene una alta letalidad, siendo los más vulnerables los menores de 2 años; representando el 89% de las defunciones. Los pacientes presentaron datos de infección diseminada. Se debe sospechar histoplasmosis en pacientes con hepatomegalia, esplenomegalia, trombocitopenia, anemia y/o leucopenia.

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“…Histoplasmosis was recognized as causing recurrent febrile episodes in adult immunocompromised patients [ 73 ] but should also be suspected in immunocompetent patients presenting with unexplained fever despite the fact that fever associated with histoplasmosis is most commonly prolonged and not recurrent in both adults and children [ 74 , 75 ]. In one pediatric immunocompetent patient, disseminated histoplasmosis was associated with intermittent fever lasting six months, bone pain, weight loss, lymphadenopathy and hepatosplenomegaly [ 76 ].…”

Section: Infectious Causesmentioning

confidence: 99%

Recurrent Fever in Children

Torreggiani

Filocamo

Esposito

2016

IJMS

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Children presenting with recurrent fever may represent a diagnostic challenge. After excluding the most common etiologies, which include the consecutive occurrence of independent uncomplicated infections, a wide range of possible causes are considered. This article summarizes infectious and noninfectious causes of recurrent fever in pediatric patients. We highlight that, when investigating recurrent fever, it is important to consider age at onset, family history, duration of febrile episodes, length of interval between episodes, associated symptoms and response to treatment. Additionally, information regarding travel history and exposure to animals is helpful, especially with regard to infections. With the exclusion of repeated independent uncomplicated infections, many infective causes of recurrent fever are relatively rare in Western countries; therefore, clinicians should be attuned to suggestive case history data. It is important to rule out the possibility of an infectious process or a malignancy, in particular, if steroid therapy is being considered. After excluding an infectious or neoplastic etiology, immune-mediated and autoinflammatory diseases should be taken into consideration. Together with case history data, a careful physical exam during and between febrile episodes may give useful clues and guide laboratory investigations. However, despite a thorough evaluation, a recurrent fever may remain unexplained. A watchful follow-up is thus mandatory because new signs and symptoms may appear over time.

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An Unusual Presentation of Disseminated Histoplasmosis: Case Report and Review of Pediatric Immunocompetent Patients from India

Cited by 7 publications

References 10 publications

Gastrointestinal histoplasmosis complicating pediatric Crohn disease: A case report and review of literature

Gastrointestinal histoplasmosis complicating pediatric Crohn disease: A case report and review of literature

Características clínicas, epidemiológicas, diagnóstico y tratamiento de los pacientes pediátricos con histoplasmosis en el Hospital Materno infantil José Domingo de Obaldía, desde enero 2008 a diciembre 2018

Recurrent Fever in Children

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