Fungal Infection Causing a Diagnostic Dilemma!

Main Article Content

Tasneem S. Bohra
Hakim Shaikh
Pralhad Prabhudesai

Abstract

Histoplasmosis is a fungal infection caused by Histoplasma capsulatum, which is distributed worldwide. Disseminated Histoplasmosis (DH) is one of its rare forms. Non-recognition of the true burden of Histoplasmosis in the Indian sub-continent is attributed to its possible misdiagnosis as Tuberculosis, malignancy or other diseases. We report a case of a young immunocompetent male who was diagnosed to have DH, later complicated by HLH. Timely diagnosis and treatment is the linchpin of management of DH, as it can prove fatal if left untreated. We present this case, taking it as our experience, to increase awareness regarding the presence of DH along with HLH, despite the immunocompetent status of our patient. Our case illustrates the challenges we posed during diagnosis; and how in TB endemic areas, pulmonary Histoplasmosis can be misdiagnosed.

Keywords:
Histoplasmosis, Hemophagocytic lymphohistiocytosis (HLH), immunocompetent, Tuberculosis, adrenal enlargement, bone marrow biopsy, skin biopsy

Article Details

How to Cite
Bohra, T. S., Shaikh, H., & Prabhudesai, P. (2021). Fungal Infection Causing a Diagnostic Dilemma!. Asian Journal of Medical Case Reports, 3(1), 13-18. Retrieved from https://globalpresshub.com/index.php/AJMCR/article/view/1120
Section
Case Reports

References

Ling Q, Zhu W, Lu Q, Jin T. Medicine SD. undefined. Disseminated histoplasmosis in an immunocompetent patient from an endemic area: A case report; 2018. ncbi.nlm.nih.gov [Internet]. [cited 2020 Oct 31];
Available:https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6086525/

Randhawa H, Pract HG-JMR. 2018 undefined. Occurrence of Histoplasmosis in the Indian Sub-Continent: An Overview and Update * INSA Emeritus Scientist & ex-Director. J Med Res Pr | [Internet]. [cited 2020 Oct 31];07:3–71.
Available:https://doi.org/10.20936/jmrp/07/03/02

Untanu R, Akbar S. SG-C reports in infectious, 2016 undefined. Histoplasmosis-induced hemophagocytic lymphohistiocytosis in an adult patient: a case report and review of the literature. hindawi.com [Internet]. [cited 2020 Oct 31];
Available:https://www.hindawi.com/journals/criid/2016/1358742/abs/

Sonavane A, PS-J of C, 2016 undefined. Disseminated histoplasmosis with haemophagocytic lymphohistiocytosis in an immunocompetent host. ncbi.nlm.nih.gov [Internet]. [cited 2020 Oct 31];
Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843300/

De D, diseases UN of hematology and infectious, 2015 undefined. Disseminated histoplasmosis in immunocompetent individuals-not a so rare entity, in India. ncbi.nlm.nih.gov [Internet]. [cited 2020 Oct 31];
Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418405/

Chang P, Rodas C. Skin lesions in histoplasmosis. Vol. 30, Clinics in Dermatology. Elsevier Inc. 2012;592–8.

Wahab N, Mohd R, Zainudin S, Journal NK-E, undefined. Adrenal involvement in histoplasmosis; 2013.
Available:ncbi.nlm.nih.gov [Internet]. [cited 2020 Oct 31];

Available:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4817423/

Garg M, Prabhakar N, Gulati A, Agarwal R, Dhooria S. Spectrum of imaging findings in pulmonary infections. Part 2: Fungal, mycobacterial, and parasitic. Polish J Radiol [Internet]. 2019 [cited 2020 Nov 1];84:e214–23.
Available:/pmc/articles/PMC6717951/?report=abstract

Guimarães AJ, Nosanchuk JD, Zancopé-Oliveira RM. Diagnosis of histoplasmosis [Internet]. Brazilian Journal of Microbiology. SBM. [cited 2020 Nov 1]. 2006;37:1–13.
Available:http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1517-83822006000100001&lng=en&nrm=iso&tlng=en

Jabr R, El Atrouni W, Male HJ, Hammoud KA. Histoplasmosis-associated hemophagocytic lymphohistiocytosis: A review of the literature. Canadian Journal of Infectious Diseases and Medical Microbiology. Hindawi Limited; 2019.

Wheat LJ, Freifeld AG, Kleiman MB, Baddley JW, Mckinsey DS, Loyd JE, et al. IDSA guidelines for management of histoplasmosis • CID. academic.oup.com [Internet]; 2007. [cited 2021 Jan 2];807.
Available:https://academic.oup.com/cid/article/45/7/807/541502