Disseminated histoplasmosis mimicking an acute appendicitis

Area of Science:

• Medical Mycology
• Infectious Diseases
• Clinical Case Studies

Background:

• Histoplasmosis presents with diverse and often misleading clinical features, complicating diagnosis.
• Disseminated histoplasmosis is a serious opportunistic infection, particularly in immunocompromised individuals.

Observation:

• A 33-year-old male initially presented with symptoms suggestive of acute appendicitis, including fever and right lower quadrant abdominal pain.
• Intraoperative findings revealed mesenteric lymphadenitis and a small bowel lesion, with thrombocytopenia and lymphopenia noted on presentation.
• The patient tested positive for HIV, indicating an immunocompromised state.

Findings:

• Histopathological examination confirmed disseminated histoplasmosis.
• The patient received initial treatment with amphotericin B, followed by oral itraconazole.
• Highly active antiretroviral therapy (HAART) was initiated for the underlying HIV infection.

Implications:

• This case highlights the varied presentations of histoplasmosis, emphasizing the need for a high index of suspicion.
• Prompt diagnosis and treatment of disseminated histoplasmosis are critical to prevent potentially fatal outcomes in immunocompromised hosts.
• Integrating antifungal therapy with antiretroviral treatment is essential for managing opportunistic infections in HIV-positive patients.