An Italian Case of Disseminated Histoplasmosis Associated with HIV

Area of Science:

• Mycology
• Infectious Diseases
• Immunocompromised Host

Background:

• Histoplasma capsulatum (H. capsulatum) is a dimorphic fungus endemic in various global regions, including the Americas and Southeast Asia.
• Progressive disseminated histoplasmosis (PDH) is a significant AIDS-defining illness in Latin America, but rarely diagnosed in Italy.
• Immunocompromised individuals, particularly those with HIV/AIDS, are at higher risk for severe H. capsulatum infections.

Observation:

• A Cuban patient residing in Italy for 10 years presented with symptoms suggestive of H. capsulatum infection.
• Microscopy of bone marrow aspirate and peripheral blood smear indicated H. capsulatum.
• Diagnosis was confirmed via fungal culture, demonstrating thermal dimorphism.

Findings:

• The patient received treatment with liposomal amphotericin B and voriconazole, followed by itraconazole maintenance therapy.
• Antiretroviral therapy (ART) was initiated during antifungal treatment.
• At 3-year follow-up, the patient showed viral suppression, optimal immune recovery, and adherence to ART.

Implications:

• This case underscores the importance of considering histoplasmosis in the differential diagnosis of opportunistic infections in immunocompromised patients.
• Clinicians should maintain a high index of suspicion for histoplasmosis in individuals from or who have traveled to endemic areas.
• Integrated management of opportunistic fungal infections and HIV is essential for successful patient recovery and long-term health.