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Histoplasmosis: Musculoskeletal Manifestations

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Infections and the Rheumatic Diseases

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Abstract

Histoplasma capsulatum is an endemic fungus in several states of the south of the United States, in Central America and South America. Histoplasma duboisii is endemic in Africa. Histoplasmosis may manifest as acute, subacute or chronic lung disease, pulmonary nodules, pericarditis, or progressive disseminated forms. Rheumatologic manifestations are rare. It can present as reactive arthritis, bone, joint or muscle infection, panniculitis and spondylitis, or systemic diseases such as ANCA vasculitis, rheumatoid arthritis, inflammatory myoptosis, adult onset Still’s disease, sarcoidosis or systemic lupus erythematosus. Histoplasmosis is the second opportunistic infection in patients treated with TNFi but has also been described in patients treated with steroids, methotrexate, leflunomide and abatacept. The gold standard for diagnosis of histoplasmosis is the demonstration of yeasts in tissues and/or their isolation in culture or body fluids; however, there is not always access to these specimens for which serological tests, antigen detection, and molecular biology techniques are employed. Mild cases can be treated with itraconazole from the beginning, but in severe cases, it is necessary to initiate amphotericin B, especially in liposomal form. After 1–2 weeks with amphotericin B (4–6 weeks for CNS histoplasmosis), the treatment with itraconazole can be consolidated.

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  1. Internal Medicine, Rheumatology, Hospital Pablo Tobón Uribe – Universidad CES, Medellin, Antioquia, Colombia

    Luis Fernando Pinto Peñaranda

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  1. LSU Health Sciences at New Orleans, Louisiana State University, New Orleans, LA, USA

    Luis R. Espinoza

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Pinto Peñaranda, L.F. (2019). Histoplasmosis: Musculoskeletal Manifestations. In: Espinoza, L. (eds) Infections and the Rheumatic Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-23311-2_21

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