Histoplasmosis: Musculoskeletal Manifestations

  • Luis Fernando Pinto Peñaranda


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.


Histoplasmosis Histoplasma capsulatum Pulmonary histoplasmosis Erythema nodosum Disseminated histoplasmosis Osteoarticular infection Amphotericin B 


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Luis Fernando Pinto Peñaranda
    • 1
  1. 1.Internal Medicine, RheumatologyHospital Pablo Tobón Uribe – Universidad CESMedellinColombia

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