Epididymo-orchitis caused by Histoplasma capsulatumin a Colombian patient

Abstract

Although histoplasmosis is generally a self-limited disease, disseminated infection can occur in patients lacking effective cell-mediated immunity, reaching virtually every organ, even the genitourinary tract in rare cases. We report a case of epididymo-orchitis in an immunocompetent 38-year-old bricklayer from the rural area of Villeta, Cundinamarca, Colombia. The patient presented with testicular pain and macroscopic scrotal changes requiring a left orchiectomy, with microbiological isolation and molecular confi rmation of Histoplasma capsulatum.

Epididymo-orchitis caused by Histoplasma capsulatum

“…Urine antigen - negative Treated with itraconazole for 6 months Deceased due to unknown cause of massive upper genitourinary bleeding 6 months later Kahn et al*, 1992 (presented at VIII international conference on aids/iii std world congress, amsterdam, july 19–24, 1992; 8: 93) [ 11 ] USA 35 Swelling of left testis and left cheek ulcer Not informed Biopsy specimen from orchiectomy positive for H. capsulatum Not informed Not informed Not informed Plazola-Hernández et al, 2020 [ 19 ] Mexico 22 Solid adherent mass in posterosuperior region of the left testis Not informed 5 x 5 × 2.5 cm left testis and a 3.5 x 2 × 2 cm nodule, with a dark brown, irregular surface of rubbery consistency. Histopathology: fungal structures suggestive of H. capsulatum Not performed Left testis simple orchiectomy Not informed Botero-García et al, 2017 [ 20 ] Colombia 38 Left testicular pain, swelling, erythema and fever for 1 month Previously healthy histopathological analysis: Hematoxylin & eosin and PAS staining showed necrotizing granulomatous epididymo-orchitis with small (2–4 μm) oval buds Positive sperm culture for H. capsulatum; positive molecular characterization Left orchiectomy +200 mg itraconazole every 12 h for 6 months Improved Sanha et al, 2022 [present paper] Brazil 66 Enlarged and hardened right testis AIDS Histopathological examination of testicular liquid under GMS stain: Presence of budding yeasts compatible with Histoplasma sp. Not performed Right orchiecromy Deceased Legend: BAL, Bronchoalveolar Lavage; CF, Complement Fixation; EIA; Enzyme immunoassay; GMS, Grocot-Gomori methenamine silver; PAS, Periodic Acid-Schiff.…”

Presentación atípica de histoplasmosis diseminada

“…Las formas de presentación dependen del estado inmunológico del paciente, de la carga fúngica inhalada y de la virulencia de cepa infectante. Las formas diseminadas en huéspedes inmunosuprimidos pueden deberse a reactivación secundaria, siendo la del aparato reproductor una rara vía de afectación (1,(7)(8)(9). Se describe un caso de histoplasmosis diseminada con compromiso testicular.…”

Histoplasmose disseminada e Aids com manifestações atípicas: relato de caso

“…A histoplasmose é uma doença fúngica, endêmica na América Central e América do Sul. 1,2,3 No Brasil, foi descrita em todas as regiões e o estado do Rio de Janeiro foi responsável pelo maior número de microepidemias. 4 Qualquer órgão pode ser acometido pela doença, mas, geralmente, as manifestações estão mais presentes em locais com alta concentração de macrófagos, principalmente em imunossuprimidos.…”