An Unusual Presentation of Disseminated Histoplasmosis: Case Report and Review of Pediatric Immunocompetent Patients from India
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Histoplasmosis is a progressive disease caused by dimorphic intracellular fungi and can prove fatal. Usually, it is present in immunocompromised individuals and immunocompetent individuals in the endemic zones. We report an unusual presentation of progressive disseminated histoplasmosis. The patient in the present case report was immunocompetent child and had fever, bone pains, gradual weight loss, lymphadenopathy and hepatosplenomegaly. Disseminated histoplasmosis (DH) was diagnosed on microscopic examination and fungal culture of bone marrow, blood, skin biopsy and lymph node aspirate. The patient died on seventh day of amphotericin B. In the absence of predisposing factors and classical clinical presentation of febrile neutropenia, lung, adrenal and oropharyngeal lesions, the disease posed a diagnostic challenge. Progressive disseminated histoplasmosis in children can be fatal despite timely diagnosis and therapy. In India, disseminated histoplasmosis is seen in immunocompetent hosts. All the pediatrics immunocompetent cases from India are also reviewed.
KeywordsDisseminated histoplasmosis (DH) Immunocompetent hosts Children Complications
The authors acknowledge the help of Dr (Prof.) Arunaloke Chakrabarti and Dr M. R. Shivaprakash, National Culture Collection of Pathogenic Fungi, PGIMER, Chandigarh, India, for reconfirming the isolate by DNA sequencing. The authors also acknowledge the help of Late Mrs. Kamlawati, Senior Technician, Department of Microbiology, V.M.M.C and Safdarjung Hospital, Delhi, India, for her technical expertise in the case.
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