Disseminated histoplasmosis with conjunctival involvement in an immunocompromised patient

Abstract

We report a case of disseminated histoplasmosis in a 37-year-old male acquired immunodeficiency syndrome patient from south India. The patient presented with high-grade fever, cough, conjunctival nodule and papulonodular hyperpigmented skin lesions. Histology of skin lesions and conjunctival nodule showed numerous intracellular Periodic Acid Schiff-positive rounded yeast cells within macrophages. Bone marrow aspirate confirmed disseminated histoplasmosis. The patient showed dramatic response after starting treatment with Amphotercin B.

Disseminated Histoplasmosis: A Fatal Opportunistic Infection in Disguise

“…Histoplasmosis spreads by inhalation of mycelial fragments and microconidia which are deposited in alveoli. [ 7 ] At 37°C in vitro and in tissues, the spores of this dimorphic fungus germinate into yeast forms which are ingested by pulmonary macrophages. The yeasts become parasitic, multiply within these cells, and travel to hilar and mediastinal lymph nodes, where they enter the blood circulation and disseminate to various organs.…”

“…[ 3 ] In India, this opportunistic infection is still an uncommon entity with isolated case reports of disseminated histoplasmosis affecting immunocompromised patients. [ 4 5 6 7 8 ] The clinical picture may be mistaken for tuberculosis or even lymphoma which are more commonly encountered. Therefore, a high level of clinical suspicion is required to diagnose this uncommon opportunistic infection in nonendemic areas.…”

Miliary tuberculosis in an Indian lady: Looking beyond miliary tuberculosis

“…An annual incidence of 4.7% have been observed, the important risk factors being a CD4+ T-cell count below 150/µL, exposure to chicken coops and prior exposure to H. capsulatum as evidenced by sensitivity testing. [ 1 ] Diabetes is also an important risk factor for histoplasmosis, considering its high prevalence. [ 2 ]…”