Progressive histoplasmosis with hemophagocytic lymphohistiocytosis and epithelioid cell granulomatosis: A case report and review of the literature. (11th May 2017)

• Record Type: Journal Article
• Authors: Schulze, Arik Bernard; Heptner, Britta; Kessler, Torsten; Baumgarten, Birgit; Stoica, Viorelia; Mohr, Michael; Wiewrodt, Rainer; Warneke, Viktoria Susanne; Hartmann, Wolfgang; Wüllenweber, Jörg; Schülke, Christoph; Schäfers, Michael; Wilmes, Dunja; Becker, Karsten; Schmidt, Lars Henning; Groll, Andreas H.; Berdel, Wolfgang E.
• Is Part Of: European journal of haematology. Volume 99:Number 1(2017)
• Page Start: 91
• Page End: 100
• Publication Date: 2017-05-11
• Subjects: epithelioid cell granulomatosis -- hemophagocytic lymphohistiocytosis -- Histoplasma capsulatum; Hematology -- Periodicals; Blood -- Diseases -- Periodicals; Blood -- Periodicals; 616.15005
• DOI: 10.1111/ejh.12886
• Languages: English
• ISSNs: 0902-4441

Abstract

Abstract: Histoplasmosis in central Europe is a rare fungal disease with diverse clinical presentations. Apart from acute pulmonary histoplasmosis and involvement of the central nervous system, the most serious clinical presentation is progressive disseminated histoplasmosis which is generally associated with severe immunodeficiency and, in particular, advanced human immunodeficiency virus infection. Here, we report on an immunocompetent female residing in a non‐endemic area, presenting with progressive disseminated histoplasmosis after a remote travel history to Thailand and Costa Rica. Diagnosis was delayed by several months due to misinterpretation of epithelioid cell granulomatosis of the intestine as Crohn's disease and of similar lung lesions as acute sarcoidosis. Prompted by clinical deterioration with signs and symptoms consistent with hemophagocytic lymphohistiocytosis, a bone marrow aspiration was performed that documented hemophagocytosis and intracellular organisms interpreted as Leishmania sp., but later identified by molecular methods as Histoplasma capsulatum . Treatment with liposomal amphotericin B followed by posaconazole led to prompt clinical improvement and ultimately cure.