Case Report: Histoplasmosis Accompanying Disseminated Tuberculosis in an Immunocompetent Adolescent Boy

The incidence of tuberculosis in India is quite high. In such a situation, empirical antitubercular therapy (ATT) is often resorted to, when some of the investigation findings are clearly diagnostic of tuberculosis. This may mean missing out on coinfections. Whereas this is particularly true for immunosuppressed patients, rarely even immunocompetent patients may present with such diagnostic dilemmas. We present the case of an adolescent boy who had been previously asymptomatic and who presented with fever with lymphadenopathy, splenomegaly, and pancytopenia. Initially, ATT was administered based on the detection of acid-fast bacteria in lymph node, caseating granulomas with Langhans giant cells, and a positive cartridge-based nucleic acid amplification test specific for Mycobacterium tuberculosis. However, when the patient failed to respond fully to the treatment, additional investigation in the form of bone marrow fungal culture led to the diagnosis of histoplasmosis.