Disseminated Histoplasmosis and Secondary Hemophagocytic Syndrome in a Non-HIV Patient
Histoplasma duboisii, a variant of Histoplasma capsulatum that causes “African histoplasmosis,” can be resistant to itraconazole, requiring intravenous amphotericin B treatment. Rarely, these patients do not respond to intravenous antifungal therapy, and in such cases, patients may progress to devel...
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| Format: | Article |
| Language: | English |
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Wiley
2015-01-01
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| Series: | Case Reports in Critical Care |
| Online Access: | http://dx.doi.org/10.1155/2015/295735 |
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| author | Muhammad Kashif Hassan Tariq Mohsin Ijaz Jose Gomez-Marquez |
| author_facet | Muhammad Kashif Hassan Tariq Mohsin Ijaz Jose Gomez-Marquez |
| author_sort | Muhammad Kashif |
| collection | DOAJ |
| description | Histoplasma duboisii, a variant of Histoplasma capsulatum that causes “African histoplasmosis,” can be resistant to itraconazole, requiring intravenous amphotericin B treatment. Rarely, these patients do not respond to intravenous antifungal therapy, and in such cases, patients may progress to develop secondary hemophagocytic lymphohistiocytosis (HLH). We present a case of a 34-year-old male patient with sickle cell disease who presented with a 5-month history of an enlarging painless axillary mass, persistent low grade fevers, night sweats, weight loss, and anorexia. An excisional biopsy of the right axillary lymph node revealed yeast and granulomas consistent with histoplasma infection. He was started on oral itraconazole. After 4 weeks of therapy, laboratory evaluation revealed worsening anemia, thrombocytopenia, and transaminitis. Due to failure of oral therapy, he was admitted for intravenous amphotericin B treatment. During his hospital course anemia, thrombocytopenia, and transaminitis all worsened. A bone marrow biopsy was done that was consistent with HLH. His clinical status continued to deteriorate, developing multiorgan failure and disseminated intravascular coagulation. He unfortunately had a cardiorespiratory arrest after eight days of admission and passed away. |
| format | Article |
| id | doaj-art-e40626ee6cad46b98eb210c46cf08c62 |
| institution | OA Journals |
| issn | 2090-6420 2090-6439 |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Critical Care |
| spelling | doaj-art-e40626ee6cad46b98eb210c46cf08c622025-08-20T02:21:34ZengWileyCase Reports in Critical Care2090-64202090-64392015-01-01201510.1155/2015/295735295735Disseminated Histoplasmosis and Secondary Hemophagocytic Syndrome in a Non-HIV PatientMuhammad Kashif0Hassan Tariq1Mohsin Ijaz2Jose Gomez-Marquez3Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Avenue, Suite No. 10 C, Bronx, NY 10457, USADepartment of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Avenue, Suite No. 10 C, Bronx, NY 10457, USADivision of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Avenue, Suite No. 12 F, Bronx, NY 10457, USADivision of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn Avenue, Suite No. 12 F, Bronx, NY 10457, USAHistoplasma duboisii, a variant of Histoplasma capsulatum that causes “African histoplasmosis,” can be resistant to itraconazole, requiring intravenous amphotericin B treatment. Rarely, these patients do not respond to intravenous antifungal therapy, and in such cases, patients may progress to develop secondary hemophagocytic lymphohistiocytosis (HLH). We present a case of a 34-year-old male patient with sickle cell disease who presented with a 5-month history of an enlarging painless axillary mass, persistent low grade fevers, night sweats, weight loss, and anorexia. An excisional biopsy of the right axillary lymph node revealed yeast and granulomas consistent with histoplasma infection. He was started on oral itraconazole. After 4 weeks of therapy, laboratory evaluation revealed worsening anemia, thrombocytopenia, and transaminitis. Due to failure of oral therapy, he was admitted for intravenous amphotericin B treatment. During his hospital course anemia, thrombocytopenia, and transaminitis all worsened. A bone marrow biopsy was done that was consistent with HLH. His clinical status continued to deteriorate, developing multiorgan failure and disseminated intravascular coagulation. He unfortunately had a cardiorespiratory arrest after eight days of admission and passed away.http://dx.doi.org/10.1155/2015/295735 |
| spellingShingle | Muhammad Kashif Hassan Tariq Mohsin Ijaz Jose Gomez-Marquez Disseminated Histoplasmosis and Secondary Hemophagocytic Syndrome in a Non-HIV Patient Case Reports in Critical Care |
| title | Disseminated Histoplasmosis and Secondary Hemophagocytic Syndrome in a Non-HIV Patient |
| title_full | Disseminated Histoplasmosis and Secondary Hemophagocytic Syndrome in a Non-HIV Patient |
| title_fullStr | Disseminated Histoplasmosis and Secondary Hemophagocytic Syndrome in a Non-HIV Patient |
| title_full_unstemmed | Disseminated Histoplasmosis and Secondary Hemophagocytic Syndrome in a Non-HIV Patient |
| title_short | Disseminated Histoplasmosis and Secondary Hemophagocytic Syndrome in a Non-HIV Patient |
| title_sort | disseminated histoplasmosis and secondary hemophagocytic syndrome in a non hiv patient |
| url | http://dx.doi.org/10.1155/2015/295735 |
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