Images in Clinical Medicine

Disseminated Histoplasmosis in a Patient with Human Immunodeficiency Virus Infection

J. Manuel Dominguez, M.D., and Karim Serri, M.D.

N Engl J Med 2002; 346:2061June 27, 2002

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Figure 1 A 37-year-old man who had emigrated to Montreal in 1990 was hospitalized because of a three-week history of high fever and weight loss. He had been given a diagnosis of human immunodeficiency virus infection five years previously but had declined treatment. The results of a physical examination and initial blood tests were unremarkable, except for the finding of mild microcytic anemia. The CD4 count was 130 cells per cubic millimeter. The results of an extended workup, including multiple imaging studies, were negative. During hospitalization, pancytopenia and markedly elevated lactate dehydrogenase levels (up to 7200 U per liter) developed. A bone marrow biopsy was performed, and analysis of the aspirate revealed Histoplasma capsulatum within a histiocyte (arrow in Panel A; Wright–Giemsa, ×100) and relative normocellularity, with erythroblastic hyperplasia, granulocytopenia, and mild hypomegakaryocytosis. H. capsulatum was also isolated from the peripheral blood, as shown within a monocyte in Panel B (arrow; Wright–Giemsa, ×100). The patient was treated successfully with antibiotics and amphotericin B, the fever resolved 10 days after the beginning of treatment, and he was discharged after 6 weeks of hospitalization.

J. Manuel Dominguez, M.D.
Karim Serri, M.D.
Hôpital Maisonneuve–Rosemont, Montreal, QC H1T 2M4, Canada

Citing Articles (3)

Citing Articles

1. 1

   Christine L. Frissora, Kenneth L. Koch. (2005) Symptom overlap and comorbidity of irritable bowel syndrome with other conditions. Current Gastroenterology Reports 7:4, 264-271
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2. 2

   Daniel Caplivski, Carlos Salama, Shirish Huprikar, Edward J Bottone. (2005) Disseminated histoplasmosis in five immunosuppressed patients: clinical, diagnostic, and therapeutic perspectives. Reviews in Medical Microbiology 16:1, 1-7
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3. 3

   Mohsen Saidinejad, Michele M. Burns, Marvin B. Harper. (2004) DISSEMINATED HISTOPLASMOSIS IN A NONENDEMIC AREA. The Pediatric Infectious Disease Journal 23:8, 781-782
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