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Disseminated histoplasmosis diagnosed on bone marrow aspiration in an immunocompetent patient.

Sharma S, Sehgal S - Blood Res (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Lady Hardinge Medical College, New Delhi, India.

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Histoplasmosis is caused by Histoplasma capsulatum variant capsulatum and H. capsulatum variant duboisiis... Disseminated histoplasmosis is usually seen in immunocompromised patients such as those with AIDS or hematological malignancies, or patients who have undergone a transplant or are receiving steroids... We present a case of disseminated histoplasmosis, diagnosed incidentally on bone marrow aspiration, in a young, immunocompetent woman... A 35-year-old woman presented with pallor, intermittent fever associated with chills, and body ache that had started 6 months earlier... In the abdomen, non-tender hepatosplenomegaly was present, 5 cm and 1 cm below the costal margin... The patient had no history of steroid intake or diabetes, the results of the recombinant K39 and rapid malaria antigen tests were negative, and human immunodeficiency virus serology was non-reactive... Symptomatic infection is uncommon in immunocompetent patients exposed to H. capsulatum... The disease spectrum in these patients includes acute pulmonary histoplasmosis, chronic cavitary histoplasmosis, granulomatous mediastinitis, mediastinal fibrosis and, uncommonly, pericarditis, pleural disease, and broncholithiasis... A high index of clinical suspicion is required to diagnose disseminated histoplasmosis in an immunocompetent patient, although timely diagnosis is important because it is associated with a high mortality... The Grocott methenamine silver technique provides good staining of the yeast forms with minimal background staining... It is also possible that large stores of iron function as part of the host defense mechanism... Yeast cells might be inhibited by high iron concentrations within the histiocytes... Further studies are required to determine the changes and deviations in iron metabolism in disseminated histoplasmosis.

No MeSH data available.


Related in: MedlinePlus

A Wright stained-smear showing numerous extracellular and intracellular yeast forms of Histoplasma capsulatum (×1,000), which were PAS positive (inset on the lower left) and gave a positive Prussian blue reaction (inset on the lower right).
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Figure 1: A Wright stained-smear showing numerous extracellular and intracellular yeast forms of Histoplasma capsulatum (×1,000), which were PAS positive (inset on the lower left) and gave a positive Prussian blue reaction (inset on the lower right).

Mentions: A 35-year-old woman presented with pallor, intermittent fever associated with chills, and body ache that had started 6 months earlier. There was no history of joint pain, vomiting, loose stools, cough, or dysuria. Respiratory and cardiovascular system examinations were normal. In the abdomen, non-tender hepatosplenomegaly was present, 5 cm and 1 cm below the costal margin. The patient had no history of steroid intake or diabetes, the results of the recombinant K39 and rapid malaria antigen tests were negative, and human immunodeficiency virus serology was non-reactive. However, a complete blood count revealed pancytopenia, and bone marrow aspirate smears showed many intracellular and extracellular yeast forms of H. capsulatum. These organisms were periodic acid Schiff-positive and gave a positive Prussian blue reaction with Perl's staining (Fig. 1). A diagnosis of disseminated histoplasmosis was made, and the patient started receiving amphotericin B, but was then lost in follow up.


Disseminated histoplasmosis diagnosed on bone marrow aspiration in an immunocompetent patient.

Sharma S, Sehgal S - Blood Res (2015)

A Wright stained-smear showing numerous extracellular and intracellular yeast forms of Histoplasma capsulatum (×1,000), which were PAS positive (inset on the lower left) and gave a positive Prussian blue reaction (inset on the lower right).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4595587&req=5

Figure 1: A Wright stained-smear showing numerous extracellular and intracellular yeast forms of Histoplasma capsulatum (×1,000), which were PAS positive (inset on the lower left) and gave a positive Prussian blue reaction (inset on the lower right).
Mentions: A 35-year-old woman presented with pallor, intermittent fever associated with chills, and body ache that had started 6 months earlier. There was no history of joint pain, vomiting, loose stools, cough, or dysuria. Respiratory and cardiovascular system examinations were normal. In the abdomen, non-tender hepatosplenomegaly was present, 5 cm and 1 cm below the costal margin. The patient had no history of steroid intake or diabetes, the results of the recombinant K39 and rapid malaria antigen tests were negative, and human immunodeficiency virus serology was non-reactive. However, a complete blood count revealed pancytopenia, and bone marrow aspirate smears showed many intracellular and extracellular yeast forms of H. capsulatum. These organisms were periodic acid Schiff-positive and gave a positive Prussian blue reaction with Perl's staining (Fig. 1). A diagnosis of disseminated histoplasmosis was made, and the patient started receiving amphotericin B, but was then lost in follow up.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Lady Hardinge Medical College, New Delhi, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Histoplasmosis is caused by Histoplasma capsulatum variant capsulatum and H. capsulatum variant duboisiis... Disseminated histoplasmosis is usually seen in immunocompromised patients such as those with AIDS or hematological malignancies, or patients who have undergone a transplant or are receiving steroids... We present a case of disseminated histoplasmosis, diagnosed incidentally on bone marrow aspiration, in a young, immunocompetent woman... A 35-year-old woman presented with pallor, intermittent fever associated with chills, and body ache that had started 6 months earlier... In the abdomen, non-tender hepatosplenomegaly was present, 5 cm and 1 cm below the costal margin... The patient had no history of steroid intake or diabetes, the results of the recombinant K39 and rapid malaria antigen tests were negative, and human immunodeficiency virus serology was non-reactive... Symptomatic infection is uncommon in immunocompetent patients exposed to H. capsulatum... The disease spectrum in these patients includes acute pulmonary histoplasmosis, chronic cavitary histoplasmosis, granulomatous mediastinitis, mediastinal fibrosis and, uncommonly, pericarditis, pleural disease, and broncholithiasis... A high index of clinical suspicion is required to diagnose disseminated histoplasmosis in an immunocompetent patient, although timely diagnosis is important because it is associated with a high mortality... The Grocott methenamine silver technique provides good staining of the yeast forms with minimal background staining... It is also possible that large stores of iron function as part of the host defense mechanism... Yeast cells might be inhibited by high iron concentrations within the histiocytes... Further studies are required to determine the changes and deviations in iron metabolism in disseminated histoplasmosis.

No MeSH data available.


Related in: MedlinePlus