Hemophagocytic lymphohistiocytosis (HLH) secondary to disseminated histoplasmosis in the setting of Acquired Immunodeficiency Syndrome (AIDS)

Asanad, Samuel; Cerk, Brendan; Ramirez, Veronica

doi:10.1016/j.mmcr.2018.01.001

Cited by 15 publications

(23 citation statements)

References 14 publications

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“…Red cell phagocytosis by macrophages on bone marrow examination can determine a diagnosis of HIHS. A comprehensive definition and classification of hemophagocytic lymphohistiocytosis are now available, but little is known regarding HIHS and no specific treatment guidance is available [45,46]. Severe clinical manifestations mimicking septic shock have been reported in around 10% of HAH cases and are probably caused by HIHS [5].…”

Section: Clinical Findingsmentioning

confidence: 99%

The Broad Clinical Spectrum of Disseminated Histoplasmosis in HIV-Infected Patients: A 30 Years’ Experience in French Guiana

Couppié¹,

Herceg²,

Bourne-Watrin³

et al. 2019

JoF

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Histoplasmosis is a common but neglected AIDS-defining condition in endemic areas for Histoplasma capsulatum. At the advanced stage of HIV infection, the broad spectrum of clinical features may mimic other frequent opportunistic infections such as tuberculosis and makes it difficult for clinicians to diagnose histoplasmosis in a timely manner. Diagnosis of histoplasmosis is difficult and relies on a high index of clinical suspicion along with access to medical mycology facilities with the capacity to implement conventional diagnostic methods (direct examination and culture) in a biosafety level 3 laboratory as well as indirect diagnostic methods (molecular biology, antibody, and antigen detection tools in tissue and body fluids). Time to initiation of effective antifungals has an impact on the patient’s prognosis. The initiation of empirical antifungal treatment should be considered in endemic areas for Histoplasma capsulatum and HIV. Here, we report on 30 years of experience in managing HIV-associated histoplasmosis based on a synthesis of clinical findings in French Guiana with considerations regarding the difficulties in determining its differential diagnosis with other opportunistic infections.

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Section: Clinical Findingsmentioning

confidence: 99%

The Broad Clinical Spectrum of Disseminated Histoplasmosis in HIV-Infected Patients: A 30 Years’ Experience in French Guiana

Couppié¹,

Herceg²,

Bourne-Watrin³

et al. 2019

JoF

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“…Treatment with tumor necrosis factor (TNF) inhibitors such as infliximab can also lead to increased risk of opportunistic infections particularly granulomatous diseases such as histoplasmosis and tuberculosis. Symptoms of disseminated histoplasmosis usually include fever, fatigue, weight loss, hepatosplenomegaly, lymphadenopathy, skin lesions, and pancytopenia [ 4 , 6 – 8 ]. There is considerable overlap of these symptoms with primary HLH, and the infection can itself trigger HLH.…”

Section: Discussionmentioning

confidence: 99%

“…Disseminated histoplasmosis is a fulminant infection which needs long-term systemic antifungal therapy. Immunosuppressive therapy can potentially worsen the underlying infection especially since histoplasmosis is typically seen to affect immunosuppressed individuals such as those with HIV or taking chemotherapy [3][4][5]. In this case report, we would like to discuss diagnosis and management of HLH and the spectrum of presentation of disseminated histoplasmosis and its treatment.…”

Section: Introductionmentioning

confidence: 99%

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Hemophagocytic Lymphohistiocytosis (HLH) in a Patient with Disseminated Histoplasmosis

Swaminathan

Vinicius

Serrins

2020

Case Reports in Hematology

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Hemophagocytic lymphohistiocytosis (HLH) is a rare condition characterized by an overwhelming inflammatory cascade activation which is often associated with rapid progression and high mortality. It may be familial with an underlying genetic mutation or triggered by infection, malignancy, and autoimmune disease. Disseminated histoplasmosis caused by histoplasma capsulatum is a granulomatous fungal disease seen typically in immunocompromised patients with varied clinical manifestations and requires long-term antifungal therapy. We present the case of a 61-year-old immunocompromised female with significant travel history who came with fever, pancytopenia, and liver failure raising suspicion for HLH that prompted a bone marrow biopsy procedure. Hemophagocytic figures consistent with HLH and numerous encapsulated fungi resembling histoplasma were visualized. She was treated with intravenous (IV) liposomal amphotericin B. Etoposide chemotherapy and interleukin-1 (IL-1) antagonist anakinra were deferred in order to limit her immunosuppression, and treatment was focused on antifungal therapy.

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“…Our patient, as well as other individuals with rheumatologic disorders (on immunosuppressant therapies), tend to have an opportunistic infection as the main trigger mechanism. Antitumor necrosis factor therapy (medication commonly used in autoimmune diseases) inhibits granuloma formation and increases the risk of systemic infections such as histoplasmosis [7].…”

Section: Discussionmentioning

confidence: 99%

A Case of Hemophagocytic Lymphohistiocytosis Secondary to Disseminated Histoplasmosis

Columbus-Morales

Maahs

Husain

et al. 2020

Case Reports in Hepatology

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Hemophagocytic lymphohistiocytosis (HLH) is a rare condition characterized by a pathologic immune dysregulation resulting in extreme inflammation. Clinical manifestations are varied but can include severe multiorgan failure and death. HLH has been associated with malignancies, autoimmune diseases, and infections, such as histoplasmosis. Histoplasmosis commonly has subclinical manifestations but can also present in its disseminated form. We present the case of an immunocompromised patient with worsening liver function caused by hepatic histoplasmosis that later triggered HLH with severe multiorgan dysfunction.

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Hemophagocytic lymphohistiocytosis (HLH) secondary to disseminated histoplasmosis in the setting of Acquired Immunodeficiency Syndrome (AIDS)

Cited by 15 publications

References 14 publications

The Broad Clinical Spectrum of Disseminated Histoplasmosis in HIV-Infected Patients: A 30 Years’ Experience in French Guiana

The Broad Clinical Spectrum of Disseminated Histoplasmosis in HIV-Infected Patients: A 30 Years’ Experience in French Guiana

Hemophagocytic Lymphohistiocytosis (HLH) in a Patient with Disseminated Histoplasmosis

A Case of Hemophagocytic Lymphohistiocytosis Secondary to Disseminated Histoplasmosis

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