Persistent fever in a pediatric renal transplant patient: Answers
Figure 1 Bone marrow aspirate (MSN stain) with budding yeast forms. Figure 2. Bone marrow aspirate smear with a rare histiocyte showing hemophagocytosis.
Fungal culture and fungal antigens (blood, bone marrow, spinal fluid)
Final diagnosis is hemophagocytic lymphohistiocytosis secondary to disseminated histoplasmosis.
Bone marrow biopsy showed presence of intracellular yeast forms along with rare histiocytes showing hemophagocytosis.
Histoplasma serum Ag was positive and fungal blood and bone marrow cultures grew H. capsulatum. MRI of the brain with contrast did not show any evidence of fungal infection.
Full body PET-CT was performed and showed multiple enlarged lymph nodes throughout the chest and abdomen, as well as splenomegaly. Diagnostic lumbar puncture was performed and cultures were sent, including fungal culture. Cerebrospinal fluid Histoplasma serum Ag was 0.96 (positive).
Additional studies for evaluating HLH were sent: SolIL2R was...
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Conflict of interest
The authors declare that they have no conflicts of interest.
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