Histoplasmosis

Philip Daoust, M.D., and Brian Schapiro, M.D.

N Engl J Med 1996; 334:700March 14, 1996

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Figure 1 A chest x-ray film (Panel A) in a 41-year-old man with human immunodeficiency virus infection who had a four-month history of fever, cough, and worsening dyspnea showed a diffuse, bilateral reticulonodular pattern. A blood smear (Panel B; Wright-Giemsa stain, ×1000) obtained on admission showed intracellular organisms in segmented neutrophils. These yeast-like organisms had a clear halo, suggesting a capsule, and were consistent with histoplasma. The diagnosis was confirmed by bronchoalveolar lavage (Panel C; Grocott's methenamine silver, ×1000), which showed small, budding yeast characteristic of histoplasma (1 to 4 μm in diameter). The patient was intubated and treated with amphotericin B. His fever resolved and he was extubated on the sixth day of treatment, with clearing of the lungs on the chest film. Three days later staphylococcal septicemia developed, and the patient had an acute cerebral event and died.

Kim Eagle, M.D.

Philip Daoust, M.D.
Brian Schapiro, M.D.
New England Medical Center Hospitals, Boston, MA 02111

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