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Acute disseminated histoplasmosis and endocarditis
P G Scapellato1, J Desse, R Negroni
1Hospital de Infecciosas F. J. Muñiz, Buenos Aires, Argentina.
Abstract:
Acute disseminated histoplasmosis is a frequent condition in HIV carriers. Thirty-five cases of endocarditis caused by Histoplasma capsulatum have been reported in international literature, and all these descriptions correspond to a context of subacute disseminated histoplasmosis. This paper presents the case of a HIV-positive patient with fever, dyspnea, weight loss, vomiting and polyadenopathies to whom histoplasmosis was diagnosed following blood-cultures and isolation of the agent responsible for cutaneous lesions, and in whom aortic-valve vegetations were found during an echocardiogram. The patient was treated with amphotericin B and had a good outcome; subsequent echocardiograms showed no vegetations. Literature on the subject is reviewed, with special emphasis on diagnosis and treatment of previously described cases.
Insights
Acute disseminated histoplasmosis is a serious concern for individuals with HIV. This case highlights a rare instance of aortic-valve vegetations in an HIV-positive patient with histoplasmosis, successfully treated with amphotericin B.
Area of Science:
- Infectious Diseases
- Cardiology
- Mycology
Background:
- Acute disseminated histoplasmosis is common in HIV-positive individuals.
- Endocarditis due to Histoplasma capsulatum is rare, typically presenting in subacute disseminated forms.
- This study focuses on a unique presentation of histoplasmosis in an immunocompromised patient.
Observation:
- A human immunodeficiency virus (HIV)-positive patient presented with fever, dyspnea, weight loss, vomiting, and polyadenopathies.
- Histoplasmosis was diagnosed via blood cultures and isolation of Histoplasma capsulatum from cutaneous lesions.
- Echocardiography revealed aortic-valve vegetations, a rare finding in this context.
Findings:
- The patient received treatment with amphotericin B for histoplasmosis.
- A positive clinical outcome was observed following treatment.
- Follow-up echocardiograms confirmed the resolution of aortic-valve vegetations.
Implications:
- This case underscores the importance of considering histoplasmosis in HIV patients with systemic symptoms and cardiac involvement.
- Early diagnosis and appropriate antifungal therapy, such as amphotericin B, are crucial for favorable outcomes.
- Further research into the cardiovascular manifestations of disseminated fungal infections in immunocompromised populations is warranted.