Limits...
Subacute progressive disseminated histoplasmosis in immunocompetent patient

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Histoplasmosis is an endemic disease in Central and South America, and is caused by Histoplasma capsulatum... It remains a frequent cause of opportunistic infection in patients whose immune systems are impaired by drugs or human immunodeficiency virus... Clinical manifestations of histoplasmosis vary from an asymptomatic infection to a progressive disseminated histoplasmosis (PDH) involving the lung, gastrointestinal tract, endovascular structures, central nervous system, adrenal glands, and bone marrow... Yoon et al. reported that the prevalence of histoplasmosis was 0.054 per 100,000 persons in South Korea; however, that study had some limitations... The accuracy of their diagnosis could not be guaranteed because they only used secondary data collected from the Health Insurance Review and Assessment Service database, and they did not distinguish between localized infections and disseminated infections... Pathologic findings of the ileocecal ulcer revealed granulomas in the submucosal area... At that time, tuberculous colitis or Crohn’s disease was suspected, but the symptoms spontaneously resolved and the patient did not visit the hospital again... In addition, an acid-fast bacillus stain and culture did not reveal Mycobacterium tuberculosis, and the patient returned to Honduras in December 2013... Laboratory findings revealed a hemoglobin level of 11.2 g/dL, a platelet count of 135,000/μL, and a white blood cell (WBC) count of 3,540/μL, containing 69% segmented neutrophils... Liver function tests determined the following results, aspartate aminotransferase 58 IU/L, alanine aminotransferase 47 IU/L, total bilirubin 0.7 mg/dL, and albumin 3.0 g/dL... An ileal biopsy showed chronic active ileitis without granuloma, and PAS and GMS staining of the biopsy specimen from the colonoscopy also revealed numerous fungal yeast that were morphologically consistent with histoplasmosis (Fig. 2)... The two specimens were also tested with an acid-fast stain and did not reveal the presence of M. tuberculosis... Exposure to H. capsulatum is common for a person living in an endemic area, although the development of a symptomatic infection is rare... However, the patient returned to Honduras and was continuously exposed to H. capsulatum.

No MeSH data available.


Adrenal gland biopsies (A, H&E, ×400; B, Periodic acid-Schiff [PAS] stain, ×400; C, Giemsa stain, ×400). (D) Bone marrow biopsy (PAS stain, ×400). The small yeast cells are visible by PAS staining (arrows).
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5016276&req=5

f2-kjim-2015-069: Adrenal gland biopsies (A, H&E, ×400; B, Periodic acid-Schiff [PAS] stain, ×400; C, Giemsa stain, ×400). (D) Bone marrow biopsy (PAS stain, ×400). The small yeast cells are visible by PAS staining (arrows).

Mentions: Gram staining and cultures from sputum and blood were negative. A bronchoscopy with bronchoalveolar lavage (BAL) was performed, and the BAL fluid was negative for an acid-fast stain and M. tuberculosis PCR. We obtained tissue from the right adrenal gland and ulceration in the terminal ileum by performing a percutaneous biopsy and colonoscopy, respectively. The adrenal gland showed extensive coagulation necrosis in the adrenal cortex with neutrophilic infiltration and numerous Periodic acid-Schiff (PAS) and Gomori methenamine sliver (GMS) positive fungal yeast, consistent with histoplasmosis. An ileal biopsy showed chronic active ileitis without granuloma, and PAS and GMS staining of the biopsy specimen from the colonoscopy also revealed numerous fungal yeast that were morphologically consistent with histoplasmosis (Fig. 2). The two specimens were also tested with an acid-fast stain and did not reveal the presence of M. tuberculosis. Histoplasma mycelial antibody and histoplasma yeast antibody complement fixation tests (Quest Diagnostics, Valencia, CA, USA) were positive with a titer of ≥ 1:32. A bone marrow exam and subsequent culture were performed due to leukopenia and thrombocytopenia aggravation that occurred on day 14 of hospitalization (WBC, 2,700/μL; hemoglobin, 10.4 g/dL; platelet count, 67,000/μL), and the biopsy also showed fungal yeast and granulomas. The symptoms improved after administration of oral itraconazole 200 mg twice daily and the patient was discharged without complications.


Subacute progressive disseminated histoplasmosis in immunocompetent patient
Adrenal gland biopsies (A, H&E, ×400; B, Periodic acid-Schiff [PAS] stain, ×400; C, Giemsa stain, ×400). (D) Bone marrow biopsy (PAS stain, ×400). The small yeast cells are visible by PAS staining (arrows).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016276&req=5

f2-kjim-2015-069: Adrenal gland biopsies (A, H&E, ×400; B, Periodic acid-Schiff [PAS] stain, ×400; C, Giemsa stain, ×400). (D) Bone marrow biopsy (PAS stain, ×400). The small yeast cells are visible by PAS staining (arrows).
Mentions: Gram staining and cultures from sputum and blood were negative. A bronchoscopy with bronchoalveolar lavage (BAL) was performed, and the BAL fluid was negative for an acid-fast stain and M. tuberculosis PCR. We obtained tissue from the right adrenal gland and ulceration in the terminal ileum by performing a percutaneous biopsy and colonoscopy, respectively. The adrenal gland showed extensive coagulation necrosis in the adrenal cortex with neutrophilic infiltration and numerous Periodic acid-Schiff (PAS) and Gomori methenamine sliver (GMS) positive fungal yeast, consistent with histoplasmosis. An ileal biopsy showed chronic active ileitis without granuloma, and PAS and GMS staining of the biopsy specimen from the colonoscopy also revealed numerous fungal yeast that were morphologically consistent with histoplasmosis (Fig. 2). The two specimens were also tested with an acid-fast stain and did not reveal the presence of M. tuberculosis. Histoplasma mycelial antibody and histoplasma yeast antibody complement fixation tests (Quest Diagnostics, Valencia, CA, USA) were positive with a titer of ≥ 1:32. A bone marrow exam and subsequent culture were performed due to leukopenia and thrombocytopenia aggravation that occurred on day 14 of hospitalization (WBC, 2,700/μL; hemoglobin, 10.4 g/dL; platelet count, 67,000/μL), and the biopsy also showed fungal yeast and granulomas. The symptoms improved after administration of oral itraconazole 200 mg twice daily and the patient was discharged without complications.

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Histoplasmosis is an endemic disease in Central and South America, and is caused by Histoplasma capsulatum... It remains a frequent cause of opportunistic infection in patients whose immune systems are impaired by drugs or human immunodeficiency virus... Clinical manifestations of histoplasmosis vary from an asymptomatic infection to a progressive disseminated histoplasmosis (PDH) involving the lung, gastrointestinal tract, endovascular structures, central nervous system, adrenal glands, and bone marrow... Yoon et al. reported that the prevalence of histoplasmosis was 0.054 per 100,000 persons in South Korea; however, that study had some limitations... The accuracy of their diagnosis could not be guaranteed because they only used secondary data collected from the Health Insurance Review and Assessment Service database, and they did not distinguish between localized infections and disseminated infections... Pathologic findings of the ileocecal ulcer revealed granulomas in the submucosal area... At that time, tuberculous colitis or Crohn’s disease was suspected, but the symptoms spontaneously resolved and the patient did not visit the hospital again... In addition, an acid-fast bacillus stain and culture did not reveal Mycobacterium tuberculosis, and the patient returned to Honduras in December 2013... Laboratory findings revealed a hemoglobin level of 11.2 g/dL, a platelet count of 135,000/μL, and a white blood cell (WBC) count of 3,540/μL, containing 69% segmented neutrophils... Liver function tests determined the following results, aspartate aminotransferase 58 IU/L, alanine aminotransferase 47 IU/L, total bilirubin 0.7 mg/dL, and albumin 3.0 g/dL... An ileal biopsy showed chronic active ileitis without granuloma, and PAS and GMS staining of the biopsy specimen from the colonoscopy also revealed numerous fungal yeast that were morphologically consistent with histoplasmosis (Fig. 2)... The two specimens were also tested with an acid-fast stain and did not reveal the presence of M. tuberculosis... Exposure to H. capsulatum is common for a person living in an endemic area, although the development of a symptomatic infection is rare... However, the patient returned to Honduras and was continuously exposed to H. capsulatum.

No MeSH data available.