Year : 2021 Month : December Volume : 10 Issue : 45 Page : 4047-4049,

Disseminated Histoplasmosis in an Immunocompromised Individual

Altous F.1, Rupak Protim Patir2, Angelia L. Khawbung3

1, 2, 3 Department of Medicine, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Assam, India.

CORRESPONDING AUTHOR

Dr. Rupak Protim Patir, Senior Resident, Department of Medicine, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta-781301, Assam, India.
Email : rpatir333@gmail.com

INTRODUCTION

Histoplasma capsulatum is a dimorphic fungus usually found in the few regions of West Bengal and Assam, the Gangetic Plains, western parts of India, and sporadically from southern and few northern Indian states.1 Humans are infected by inhalation of microconidia and mycelial fragments of H. capsulatum.2 It commonly infects immunocompromised patients (HIV/AIDS, transplant patients and patients receiving immunosuppressive agents). In immunocompromised patients, it presents as nonspecific symptoms such as fever of unknown origin, weight loss, oral and aphthous ulcers, lymphadenopathy and hepatosplenomegaly.3 Here, we are reporting a case of disseminated histoplasmosis in an immunocompromised patient.

PRESENTATION OF CASE

A 47-year-old male, a newly diagnosed immunocompromised patient had presented with low-grade fever, weight loss, cough, decreased appetite, loose stool, worsening of breathlessness for 1 year. He was taking antitubercular treatment for 6 months before (radiologically diagnosed) and later discontinued the medication. He was afebrile (Temp 99 , pulse 114/min regular), hypotensive 90/60, respiratory rate of 23/min, pallor and malnourished with wasting. On laboratory investigation revealed pancytopenia with Hb-4.7 g/dl, TC-2070 cells/mm3 (N-54.5, L-43.5, E-0.5, M-1), MCV- 58, MCH – 18.6, MCHC - 32, platelet count – 90,000/mm3, RBC – 2.47 lakhs/mm3, reticulocyte count – 3.5 %  in complete blood count. Liver function test abnormal (Total bilirubin 6 mg/dl, unconjugated bilirubin 4.3 mg/dl, AST-98 IU/L, ALT – 28 IU/L, AlkP – 217 IU/L, S. Albumin – 1.5 g/dl, Globulin – 3.2 g/dl ). Thyroid function test, renal and electrolyte parameters were normal, S. Iron – 25 mg/dl, S. Ferritin - 528 mg/dl, TIBC – 183 mg/dl, ESR – 45. HRCT thorax revealed multiple tiny opacities distributed over bilateral lung fields f/s/o milliary tuberculosis. USG revealed acute calculous cholecystitis. Sputum AFB and Gene Xpert were negative. Bone marrow aspiration cytology was done and a bone marrow smear with Giemsa stain showed intracellular yeast cells. He was treated for progressive disseminated histoplasmosis.