Disseminated histoplasmosis in a non-immunocompromised child

Area of Science:

• Mycology
• Pediatric Infectious Diseases
• Immunology

Background:

• Disseminated histoplasmosis is a rare fungal infection, typically seen in immunocompromised individuals.
• This case highlights a non-immunocompromised child presenting with severe symptoms mimicking other infections.
• Early diagnosis is crucial for effective management and preventing severe complications.

Observation:

• A 2-year-old girl presented with a 2-month history of fever, bloody diarrhea, severe wasting, anemia, hepatosplenomegaly, and lymphadenopathy.
• Initial investigations including septic screen and Salmonella enteriditis culture were inconclusive or misleading.
• Bone marrow and lymph node biopsies revealed Histoplasma capsulatum, despite negative HIV screening and normal immunoglobulin levels.

Findings:

• The patient exhibited pancytopenia, disseminated intravascular coagulation, and impaired T cell function and phagocytic activity.
• Treatment with intravenous amphotericin B followed by oral fluconazole resulted in clinical improvement.
• Immune function tests normalized three months after completing treatment, suggesting a transient immune defect.

Implications:

• This case underscores the importance of considering histoplasmosis in non-immunocompromised children with prolonged, severe febrile illnesses and gastrointestinal symptoms.
• It emphasizes the need for thorough diagnostic workup, including biopsies, when initial investigations are unrevealing.
• The successful treatment and recovery of immune function highlight the efficacy of antifungal therapy and the potential for immune reconstitution.