Histoplasmosis and Kidney Disease in Patients with AIDS

Abstract

Renal disease in patients infected with human immunodeficiency virus (HIV) often presents with significant proteinuria and progressive renal failure; focal glomerulosclerosis is the most common renal pathology identified. To our knowledge, we report the first case of nephrotic-range proteinuria and preserved renal function in an HIV-infected patient in association with disseminated histoplasmosis. The initial level of proteinuria was 12.5 g/24 h. The patient developed a concomitant lesion on his neck, which was biopsied and identified as Histoplasma capsulatum by fungal stains and culture. The serum CF titer of antibody against yeast antigens of H. capsulatum was 1:8. The level of serum albumin decreased to 2.0 g/dL, and the level of serum cholesterol increased to 284 mg/dL. Immunohistochemical staining of renal biopsy tissue demonstrated immune complexes within the mesangium; H. capsulatum antigen was also demonstrated in the mesangium. Therapy with oral itraconazole resulted in marked clinical improvement. The findings in this case emphasize the need to rule out treatable causes of the nephrotic syndrome in AIDS, especially in cases of immune-complex glomerulonephritis.

Risk Factors for Death in Acquired Immunodeficiency Syndrome–associated Disseminated Histoplasmosis

“…Several studies have shown the occurrence of hepatomegaly and/or high levels of AST and alanine aminotransferase in patients with histoplasmosis. 12,[14][15][16][17] Respiratory insufficiency is known to be a classic risk factor for death in patients with disseminated histoplasmosis, and this was confirmed in our study. Univariate analysis showed that serum creatinine levels > 1.5 mg/dL on hospital admission were associated with death.…”

Disseminated Histoplasmosis in a 13-year-old girl: A case report

“…Bullock et al in 1979 reported a transient mesangiopathic glomerulonephritis in a patient with disseminated histoplasmosis and eosinophilia 14 . In another case report in 1997, Burke et al noted a nephrotic range proteinuria in a 46 year old HIV positive black man 13 who also had disseminated histoplasmosis. Renal biopsy in their patient demonstrated mesangio-proliferative glomerulonephritis.…”

“…It can also be immune complex mediated resulting in glomerulonephritis but it is rare 13 . Bullock et al in 1979 reported a transient mesangiopathic glomerulonephritis in a patient with disseminated histoplasmosis and eosinophilia 14 .…”

“…While the patient was alive, she had proteinuria (not in nephrotic range), hematuria, hypertension and oedema in keeping with glomerulonephritis but also had renal insufficeincy. Proliferative glomerulonephritis with or without renal insufficiency has been associated with immune complex deposition 13 .…”

An Unusual Penetrating Neck Trauma In Zone III

“…[11][12][13] Patients with CD4 counts of less than 150 cells/ µl are at increased risk. [14][15][16] Mucous membrane lesions are seen in disseminated histoplasmosis.…”