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Passive Administration of Monoclonal Antibodies Against H. capsulatum and Others Fungal Pathogens
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[Chronic central nervous system histoplasmosis in an immunocompetent patient]

F J Carod-Artal1, M Venturini, E Gomes

  • 1Servicio de Neurología, Hospital Sarah Centro, Red Sarah de Hospitales de Rehabilitación, Brasilia, DF, Brazil. javier@sarah.br

Neurologia (Barcelona, Spain)
|June 3, 2008
PubMed
Abstract

Insights

This case report details a rare instance of chronic central nervous system (CNS) histoplasmosis in an immunocompetent patient. Diagnosis of this disseminated fungal infection was confirmed through cerebrospinal fluid (CSF) culture.

Area of Science:

  • Infectious Diseases
  • Mycology
  • Neurology

Background:

  • Histoplasma capsulatum is endemic in the Americas, typically causing self-limiting pulmonary infections.
  • Disseminated histoplasmosis commonly affects immunocompromised individuals.
  • Isolated central nervous system (CNS) histoplasmosis is rare, especially in immunocompetent patients.

Observation:

  • A 34-year-old immunocompetent male presented with chronic meningitis, meningovascular histoplasmosis with stroke, acute myelopathy, and recurrent hydrocephalus.
  • Cerebrospinal fluid (CSF) analysis revealed elevated white blood cells, protein, and decreased glucose.
  • Brain and spinal cord MRI showed hydrocephalus, meningeal enhancement, and myelopathy.

Findings:

  • Microscopic examination of CSF revealed yeasts, and cultures confirmed Histoplasma capsulatum.
  • Biopsy showed chronic inflammation without granulomata.
  • The patient was treated with amphotericin B, fluconazole, and itraconazole.

Implications:

  • Chronic CNS histoplasmosis can manifest with diverse neurological symptoms, including recurrent strokes and myelopathy.
  • Specific CSF cultures are crucial for diagnosing rare cases of neurohistoplasmosis.
  • Early diagnosis and treatment are vital for managing this severe fungal infection.

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