Source
Gastroenterologie, Hepatologie und Endokrinologie, Innere Medizin I, Robert-Bosch-Krankenhaus, Stuttgart, Germany. Markus.Escher@rbk.de
Abstract
HISTORY AND ADMISSION FINDINGS:
A 19-year-old HIV-positive man was admitted with fever of unknown origin and poor general condition. Antiretroviral therapy had been stopped by the patient eight months prior to admission.
INVESTIGATIONS:
Laboratory tests revealed pancytopenia, high viral load and low count of T-helper cells (13/µl). Computer tomography of the thorax showed small patchy infiltrations. Extensive examinations (microbiology, laboratory tests, multiple investigations) revealed no pathogen. Liver biopsy proved disseminated histoplasmosis.
TREATMENT AND COURSE:
Liposomal amphotericin B was started and switched to oral itraconazole after 14 days with itraconazole. With this treatment the patient condition improved and fever stopped. T-helper cells increased and the patient was discharged.
CONCLUSION:
Disseminated histoplasmosis as an AIDS-defining opportunistic infection is uncommon (particularly as the patient had not been abroad in the last four years) and can be a life-threatening complication. Diagnosis must be confirmed by invasive methods especially in patients with compromised immune status and rapid clinical progression.
© Georg Thieme Verlag KG Stuttgart · New York.