Histoplasmosis Dressed as Kaposi
Critical Care Medicine
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Introduction: Histoplasmosis is a rare fungal infection caused by Histoplasma capsulatum which is normally found in soil in certain areas of the country. People ordinarily will inhale spores from the fungus which will then cause a respiratory infection, usually in immunocompromised hosts. Most immunocompetent individuals will mount a response and rid themselves of the fungus, but some immunocompromised hosts can develop severe symptoms and develop systemic findings Methods: A 28-year-old male who is a native of Las Vegas, with a history of HIV presented to the hospital for shortness of breath, diarrhea and fever. Physical exam revealed an ill-appearing tachypneic male, covered in circular lesions on upper back as well as bilateral lower extremities. Laboratory studies were suggestive of Anemia, Leukopenia, elevated transaminases, hypernatremia and acute kidney injury with Creatinine of 4.82. CXR revealed bilateral interstitial lung opacities and CT scan of the Chest revealed multiple ground glass nodular opacities, concerning for infectious etiology. The patient underwent full infectious workup pancultures. CD4 count and HIV viral load were collected which revealed HIV load of 5,800,000; further biopsy of the skin lesions was obtained with a working diagnosis of Kaposi sarcoma or coccidiomycosis. He was empirically started on Bactrim/Vancomycin/Zosyn sadly his respiratory status worsened to the point of intubation complicated with metabolic acidosis needed CRRT. pancultures where positives for non-candida albicans yeast later ID as Histoplasma capsulatum. Patient was started on Fluconazole/Amphotericin-B. Unfortunately, the patient condition worsened due to complications of disseminated histoplasmosis, and he ultimately expired. Post mortem results for the skin biopsy, originally thought to be Kaposi’s, came back positive for Histoplasmosis. Results: This case is significant because it highlights the symptoms and presentation of a rare fungal infection, disseminated histoplasmosis, and it’s complications in an immunocompromised patient with no high-risk travel or exposure. Physicians should be aware of the similarities of symptoms caused by Disseminated Histoplasmosis to other disorders and have this disease in their differentials, especially when treating immunocompromised hosts.
Fungi | Virus Diseases
Histoplasmosis Dressed as Kaposi.
Critical Care Medicine, 49(1),