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[A case of acquired immunodeficiency syndrome (AIDS) with histoplasmosis]
Abstract:
Fungal infection is a major opportunistic infection in AIDS. Histoplasmosis is often seen in American AIDS, but only one case has been reported in Japan. We report a AIDS case of with histoplasmosis in Japan. The patient was a forty year old male living in the U.S from 1987 to 1990. He was diagnosed as candidial esophagitis in July, 1994, and human immunodeficiency virus type 1 (HIV) antibody positive led to a diagnosis of AIDS. He was admitted to our hospital with fever and lymphadenopathy (neck, abdomen) in August. The therapy for candidial esophagitis was successful and he was recovering, but he was newly diagnosed as atypical mycobacteriosis and Kaposi's sarcoma. Though the fever was slight, it persisted. He was discharged from our hospital in October. He was readmitted for a high fever and dehydration in December, but died after a week from disseminated intravascular coagulation (DIC). Histoplasma capsulatum was found by blood and ascites cultures on second admission. Many yeast like histoplasma cells in granuloma of the liver were found at autopsy. For moderate or severe histoplasmosis, amphotericin B is generally used as the first induction therapy. Fluconazole (FLCZ) is used as a maintenance therapy. We did not use amphotericin B, but used FLCZ because we did not diagnose histoplasmosis before death, and his general condition became worse. The effect of FLCZ therapy was unclear in our case because he had other infections. We expect that AIDS with histoplasimosis will increase in Japan through HIV infected patients infected in the U.S.A.
Insights
This case report details a rare instance of histoplasmosis in an AIDS patient in Japan. Early diagnosis and treatment are crucial for managing this opportunistic fungal infection in immunocompromised individuals.
Area of Science:
- Infectious Diseases
- Mycology
- Immunology
Background:
- Fungal infections are significant opportunistic infections in Acquired Immunodeficiency Syndrome (AIDS) patients.
- Histoplasmosis, a fungal infection, is prevalent in American AIDS cases but rare in Japan.
- This report highlights a unique case of histoplasmosis in an AIDS patient in Japan.
Observation:
- A 40-year-old male with a history of living in the U.S. was diagnosed with HIV and later AIDS.
- The patient presented with candidal esophagitis, atypical mycobacteriosis, and Kaposi's sarcoma.
- Histoplasma capsulatum was identified post-mortem via blood, ascites cultures, and liver biopsy.
Findings:
- The patient experienced persistent fever and multiple opportunistic infections.
- Disseminated intravascular coagulation (DIC) led to the patient's death.
- Fluconazole was administered due to a lack of early histoplasmosis diagnosis, with unclear therapeutic effect.
Implications:
- The case underscores the potential increase of histoplasmosis in Japan among HIV-infected individuals returning from endemic areas.
- It emphasizes the need for heightened awareness and diagnostic vigilance for histoplasmosis in Japanese AIDS patients.
- This case contributes to understanding the clinical presentation and management challenges of rare opportunistic infections in immunocompromised populations.