Deoxycholate amphotericin for histoplasmosis in a patient with poor kidney function

Area of Science:

• Mycology
• Infectious Diseases
• Immunology

Background:

• Disseminated histoplasmosis is a severe opportunistic infection in individuals with advanced HIV.
• Low CD4 counts (e.g., 13 cells/uL) indicate profound immune deficiency, increasing susceptibility to fungal infections.
• Pancytopenia and organ dysfunction are common clinical manifestations of disseminated fungal infections in immunocompromised patients.

Observation:

• A 48-year-old male with HIV presented with fever, weight loss, pancytopenia, and abnormal liver and kidney function tests.
• Bone marrow biopsy revealed yeast forms consistent with histoplasmosis.
• Despite financial limitations precluding the preferred liposomal amphotericin B, deoxycholate amphotericin B was administered intravenously.

Findings:

• Intravenous deoxycholate amphotericin B treatment for 12 days led to significant clinical improvement.
• The patient's condition stabilized, and he was transitioned to oral itraconazole for step-down therapy.
• Successful management of disseminated histoplasmosis was achieved with a less preferred but accessible antifungal agent.

Implications:

• This case highlights the feasibility of treating disseminated histoplasmosis with deoxycholate amphotericin B in resource-limited settings.
• It underscores the importance of prompt diagnosis and accessible treatment for opportunistic infections in advanced HIV.
• Effective management strategies are crucial for improving outcomes in immunocompromised patients with severe fungal infections.