Journal
DIAGNOSTIC MICROBIOLOGY AND INFECTIOUS DISEASE
Volume 57, Issue 4, Pages 429-433Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.diagmicrobio.2006.09.010
Keywords
histoplasmosis; histoplasma capsulatum; ileal perforation; reactive hemophagocytic syndrome; hemophagocytosis; polymerase chain reaction; PCR; real-time PCR; amphotericin B; amphotericin B lipid complex; Abelcet; acquired immunodeficiency syndrome; human immunodeficiency virus; Puerto Rico
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The following case illustrates an ileal perforation and reactive hemophagocytic syndrome (RHS) resulting from disseminated histoplasmosis in a patient with Human Immunodeficiency Virus (HIV) from Puerto Rico. Although the diagnosis was established by histopathologic findings and a positive bone marrow culture, Histoplasma capsulatum-specific real-time Polymerase Chain Reaction (PCR) allowed to confirm the diagnosis from formalin-fixed, paraffin-embedded tissue. Interestingly, the Histoplasma antigens in both serum and urine samples were falsely negative. Amphotericin B lipid complex (Abelcet), followed by oral itraconazole, led to a successful response and resolution of symptoms. A short review of the clinical signs and symptoms, diagnostic tests, and therapeutic options for disseminated histoplasmosis is done, with emphasis on the role of Histoplasma-specific real-time PCR as a molecular diagnostic tool and the efficacy of treatment with one of the lipid formulations of amphotericin B. (c) 2007 Elsevier Inc. All rights reserved.
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