Intracerebral hemorrhage in disseminated histoplasmosis in advanced HIV infection: A case report

Disseminated histoplasmosis is a severe systemic mycosis typically seen in immunocompromised individuals. Though CNS involvement occurs in a small subset of patients, associated intracranial hemorrhage is an exceptionally rare and poorly documented complication.

A 26-year-old woman with untreated HIV from an endemic region presented with weight loss, jaundice, and lymphadenopathy. Her clinical course progressed to seizures and meningeal signs, initially suggesting tuberculous meningitis. However, neuroimaging revealed a left temporo-occipital hematoma and subarachnoid hemorrhage. Despite severe thrombocytopenia, a lymph node biopsy and positive Histoplasma urinary antigen confirmed Histoplasma capsulatum. Following targeted treatment with amphotericin B and subsequent antiretroviral therapy, the patient achieved a remarkable neurological recovery.

Disseminated histoplasmosis can involve CNS and cause rare intracranial hemorrhage, which may mimic cerebral tuberculosis. In endemic regions and immunocompromised patients, early diagnosis and immediate antifungal therapy are vital, serving as primary determinants for a favorable neurological prognosis.