Atypical Presentations of Progressive Disseminated Histoplasmosis in an Immunocompetent Adult: Ectopic Calcification (Aneurysm of Sinus of Valsalva) and Large Vessel (Left Subclavian Artery) Stenosis in the Background of Adrenal Insufficiency

Abstract

Histoplasmosis is a systemic fungal disease caused by the dimorphic fungus Histoplasma capsulatum and is more common in immunocompromised patients. Histoplasmosis can present with a wide range of clinical manifestations from asymptomatic illness to severe organ dysfunctions and may need hospitalization. Histoplasmosis is a major opportunistic infection in North and Central America. Disseminated histoplasmosis is a progressive extrapulmonary infection, caused by hematogenous spread, mostly found in immunosuppressed patients.
 Reports of histoplasmosis in nonendemic regions are very rare. Due to the varied and nonspecific clinical manifestations of histoplasmosis, most of the infections are misdiagnosed or underreported.
 Here, we report a case of disseminated histoplasmosis in an immunocompetent individual from a non-endemic zone in eastern India, presented with long term fever along with ectopic calcification (Aneurysm of Sinus of Valsalva) and large vessel (left subclavian artery) stenosis in the background of adrenal insufficiency.