Disseminated Histoplasmosis in an Immunocompetent Host presenting as Pyrexia of unknown origin (PUO)

Abstract

Histoplasmosis is a progressive granulomatous disease caused by intracellular dimorphic  fungus Histoplasma capsulatum. The fungus present in the soil infects through inhalational route and can manifest as any of the three main types – Acute primary pulmonary type, chronic cavitatory or progressive  disseminated. In Disseminated histopasmosis (DH) the fungus is detected from more than one location in the body. This is the rarest form of all three types and is usually present in immunocompromised individuals. We report the case of a 27-year-old immunocompetent patient who presented with prolonged fever, weight loss, pain abdomen and skin lesions. She was found to have hepatosplenomegaly and pancytopenia. Biopsy from skin lesions and bone marrow stained positive for Histoplasma capsulatum sp. She was treated with amphotericin B for 28 days, followed by oral itraconazole for 6 months, leading to complete resolution of the disease. This case is interesting due to the presence of disseminated histoplasmosis in an immunocompetent host with prominent skin lesions.