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Reactivation of Histoplasmosis Disseminated into the Central Nervous System Presenting as a Stroke

Linda Klumpp1, Gustine Liu-Young2, Fagun Modi3

  • 1Internal Medicine, Citrus Memorial Hospital, Inverness, USA.

Cureus
|February 7, 2020
PubMed

Insights

This case highlights reactivation disseminated histoplasmosis in an immunocompetent patient presenting with stroke-like symptoms. Early diagnosis and treatment are crucial for managing this rare but serious fungal infection.

Area of Science:

  • Infectious Diseases
  • Mycology
  • Neurology

Background:

  • Histoplasmosis is a common endemic mycosis in the US, with potential for reinfection or recurrence, especially in immunocompromised individuals.
  • Reactivation of histoplasmosis can occur, particularly in patients with prior exposure or treatment, even without overt signs of immunodeficiency.

Observation:

  • A 75-year-old immunocompetent male presented with stroke-like symptoms including falls, speech impairment, tremor, confusion, and weakness.
  • Neurological workup revealed diffuse brain dysfunction on EEG and cerebrospinal fluid (CSF) analysis showed elevated white blood cells and protein, with lymphocytic predominance.
  • Previous treatment for oral histoplasmosis was noted; CSF and serology were positive for Histoplasma antigen and antibodies, respectively.

Findings:

  • The patient was diagnosed with reactivation disseminated histoplasmosis, confirmed by positive CSF antigen and serology.
  • Treatment with liposomal amphotericin B followed by lifelong itraconazole led to clinical improvement and decreasing antibody titers.

Implications:

  • Histoplasmosis should be considered in the differential diagnosis for chronic meningitis, stroke-like presentations, and neurological deficits, even in immunocompetent patients.
  • This case underscores the importance of a thorough patient history, including prior fungal infections, for diagnosing and managing disseminated histoplasmosis.
  • Long-term antifungal therapy may be necessary for patients with a history of histoplasmosis to prevent recurrence.
Keywords:
amphotericin bcentral nervous system (cns)disseminationhistoplasma capsulatumhistoplasmosisimmunocompetent patientitraconazolemycosisreactivationstroke

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