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Disseminated histoplasmosis in a non-immunocompromised child.

M Hasliza1, N A Nur Atiqah, C B Lim

  • 1Institute of Paediatrics, Hospital Kuala Lumpur, Jalan Pahang.

The Medical Journal of Malaysia
|September 6, 2000
PubMed
Summary
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A rare case of disseminated Histoplasma capsulatum infection in a non-immunocompromised child presented with prolonged fever and diarrhea. Prompt diagnosis and treatment with amphotericin B and fluconazole led to recovery and normalized immune function.

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:

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  • 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.