DISSEMINATED HISTOPLASMOSIS LEADING TO HAEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS IN AN IMMUNOCOMPETENT PATIENT
Keywords:histoplasmosis, hemophagocytic lymphohistiocytosis
Background: Emerging fungal infections can pose a serious threat in contemporary healthcare due to host variations, clinical presentation and emerging resistance. Histoplasma capsulatum is a thermally dimorphic fungus, which acts as a Trojan horse by residing inside macrophages. Histoplasmosis is an emerging infection and its association with hemophagocytic lymphohistiocytosis (HLH) in immunocompetent patients has been scantily reported in the literature.
Objective. The aim of the study was to explore disseminated histoplasmosis with the help of case report.
Methods: A case report of histoid leprosy is presented.
Results: A male patient of 47 yearsof age, under treatment for chronic obstructive pulmonary disease for five years and diabetes mellitus Type-II for two years, presented with fever of unknown origin (FUO) with evidence of HLH in the bone marrow. Core biopsy of the liver and spleen showed a dense tissue infiltrate with vacuolated histiocytes containing histoplasma capsulatum, eosinophils, some lymphocytes and plasma cells.
Conclusion: Histoid leprosy is a discrete infrequent form of multibacillary leprosy with distinctive clinical, bacteriological and histomorphological features. Histopathologic examination with modified fite stain remains the mainstay of diagnosis.
Wheat LJ, Conger NG. Histoplasmosis. In: Hospenthal DR, Rinaldi MG, eds. Diagnosis and Treatment of Human Mycoses. New Jersey: Humana Press, 2008:318-29.
Khan ID, Sahni AK, Sen S, et al. Outbreak of Prototheca wickerhamii algaemia and sepsis in a tertiary care chemotherapy oncology unit. Medical Journal Armed Forces India. 2018 Oct 1;74(4):358-64.
Khan ID, Rajmohan KS, Gupta RM, et al. Invasive Cerebral and Pulmonary Mucormycosis in an Immunocompromised patient. J Basic & Clin Med 2017, 6(2): 9-11.
Khan ID, Sahni AK, Basu A, et al. Trichosporonasahii urinary tract infection in immunocompetent patients. Medical Journal Armed Forces India. 2015 Oct 1;71(4):373-6.
Danish Khan I, Makkar A, Malik A, Khan S, Mehdi I, Arif S, Aden D, Somayaji P, Roomi K. Curvularia keratomycosis after cataract surgery. Journal of Archives in Military Medicine. 2017(In Pre).
Gupta AK, Khan ID, Shaw SC, Faisal FA, Sahu S, Khan S, Brijwal M, Shende T, Kundu N, Khalil S, Bhat S. Candida Parapsilosis Neonatal Sepsis. Journal of Basic and Clinical Medicine. 2016 Apr 13;5(1):13-5.
Khan ID, Rajmohan KS, Jindal AK, Gupta RM, Khan S, Shukla M, Singh S, Mustafa S, Tejus A, Narayanan S. Panresistant superbugs: are we at the edge of a ‘microbial holocaust’. International Journal of Medicine and Medical Research. 2017 Dec 29;3(2):39-44.
Danish Khan I, Mohan Gupta R, Sen S, Rajmohan KS, Kumar Jindal A, Makkar A, Rahman Razi F, Banerjee P, Panda P, Lakshmi Nair G, Kulhari K. Emerging antimicrobial resistance and evolving healthcare: Dangerous crossroads for the community and the military. Journal of Archives in Military Medicine. 2017(In Pre).
Khan ID, Gupta N, Rangan NM, Singh R, Sharma AK, Khurana A, Rudra P, Krushnarao MS. Evaluation of pre and post analytical variables in clinical microbiology services in multidisciplinary ICU of a medical college and tertiary care hospital. Journal of Basic and Clinical Medicine. 2016 Apr 5;5(1):2-4.
Khan ID. Challenges and opportunities in diagnosis and management of infectious diseases in developing country healthcare system. Journal of Basic and Clinical Medicine. 2016 Apr 5;5(1).
Lo MM, Mo JQ, Dixon BP, Czech KA. Disseminated histoplasmosis associated with hemophagocytic lymphohistiocytosis in kidney transplant recipients. American Journal of Transplantation. 2010 Mar;10(3):687-91.
Khan ID, Sahni AK, Bharadwaj R, Lall M, Jindal AK, Sashindran VK. Emerging organisms in a tertiary healthcare set up. medical journal armed forces india. 2014 Apr 1;70(2):120-8.
van Koeveringe MP, Brouwer RE. Histoplasma capsulatum reactivation with haemophagocytic syndrome in a patient with chronic lymphocytic leukaemia. Neth J Med. 2010 Dec;68(12):418-21.
Phillips J, Staszewski H, Garrison M. Successful treatment of secondary hemophagocytic lymphohistiocytosis in a patient with disseminated histoplasmosis. Hematology. 2008 Oct;13(5):282-5.
Sanchez A, Celaya AK, Victorio A. Histoplasmosis-associated hemophagocytic syndrome: a case report. AIDS Read. 2007 Oct;17(10):496-9.
Wang Z, Duarte AG, Schnadig VJ. Fatal reactive hemophagocytosis related to disseminated histoplasmosis with endocarditis: an unusual case diagnosed at autopsy. South Med J. 2007 Feb;100(2):208-11.
Huang AM. Hemophagocytic lymphohistiocytosis and disseminated histoplasmosis. Blood. 2014 Apr 17;123(16):2449.
Hegerova LT, Lin Y. Disseminated histoplasmosis: a cause of hemophagocytic syndrome. InMayo Clinic Proceedings 2013 Oct 1 (Vol. 88, No. 10, p. e123). Elsevier.
Joshi SA, Kagal AS, Bharadwaj RS, Kulkarni SS, Jadhav MV. Disseminated histoplamosis. Indian journal of medical microbiology. 2006 Oct 1;24(4):297-8.
Khan ID, Sahni AK. Bacterial infections and emerging resistance in renal transplant recipients. Bangladesh Journal of Medical Science. 2015;14(1): 14-21.
Khan ID, Basu A, Kiran S, Trivedi S, Pandit P, Chattoraj A. Device-Associated Healthcare-Associated Infections (DA-HAI) and the caveat of multiresistance in a multidisciplinary intensive care unit. Medical Journal Armed Forces India. 2017 Jul 1;73(3):222-31.
Khan ID, Dogra PM, Ramphal SK, Khan S, Konar J, Palit A, Srivastava N, Aggarwal P, Haleem S, Alam S. Polymicrobial infections in a teenaged Renal Transplant Recipient. Journal of Basic and Clinical Medicine. 2015 Jul 30;4(1):37-9.
Khan ID, Lall M, Sen S, et al. Multiresistant Elizabethkingia meningoseptica Infections in Tertiary Care. MJAFI. 2014;71(3):66-7.
Khan ID, Mukherjee T, Gupta S, Haleem S, Sahni AK, Banerjee S, Konar J. Ochrobactrum anthropi sepsis in intensive tertiary care. Journal of Basic and Clinical Medicine. 2014 Nov 18;3(1):18-20.
Khan ID, Sahni AK, Bharadwaj R, Anwar I, Jain V, Khan S, Chowdhury A, Dwivedi AK, Gupta AK, Zaman S, Alam S. Cerebral toxoplasmosis diagnosed by stereotactic brain biopsy leading to detection of HIV infection. Journal of Basic and Clinical Medicine. 2016 Apr 5;5(1): 5-7.
Faiolla RC, Coelho MC, Santana RD, Martinez R. Histoplasmosis in immunocompetent individuals living in an endemic area in the Brazilian Southeast. Revista da Sociedade Brasileira de Medicina Tropical. 2013 Aug;46(4):303-6.
García-Marrón M, García-García JM, Pajín-Collada M, Álvarez-Navascués F, Martínez-Muñiz MA, Sánchez-Antuña AA. Chronic pulmonary histoplasmosis diagnosed in a nonimmunosuppressed patient 10 years after returning from an endemic area. Archivos de Bronconeumología ((English Edition)). 2008 Jan 1;44(10):567-70.
Staffolani S, Buonfrate D, Angheben A et al. Acute histoplasmosis in immunocompetent travelers: a systematic review of literature. BMC Infect Dis 18, 673 (2018).
Zhu LL, Wang J, Wang ZJ, Wang YP, Yang JL. Intestinal histoplasmosis in immunocompetent adults. World J Gastroenterol. 2016 Apr 21;22(15): 4027-33.
How to Cite
Authors who sent their manuscript to International Journal of Medicine and Medical Research agree to the following terms:
1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License CC-BY-NC that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
2. Authors able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).