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Progressive histoplasmosis with hemophagocytic lymphohistiocytosis and epithelioid cell granulomatosis: A case report and review of the literature
Author(s) -
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.
Publication year - 2017
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.12886
Subject(s) - histoplasmosis , hemophagocytic lymphohistiocytosis , medicine , hemophagocytosis , itraconazole , pathology , sarcoidosis , histoplasma , dermatology , disease , immunology , bone marrow , antifungal , histoplasma capsulatum , pancytopenia
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.