Hofmann, Eveline; Mühlethaler, Konrad; Pollak, Matthias; Ott, Daniel; Bienz, Nora; Zimmerli, Stefan; Hirzel, Cédric (2022). Travel related histoplasmosis - a diagnostic challenge in a patient with tumor necrosis factor alpha (TNF-α) inhibitor therapy. Tropical Diseases, Travel Medicine and Vaccines, 8(1), p. 21. BioMed Central 10.1186/s40794-022-00178-2
|
Text
s40794-022-00178-2.pdf - Published Version Available under License Creative Commons: Attribution (CC-BY). Download (1MB) | Preview |
INTRODUCTION
In a non-endemic setting, disseminated histoplasmosis is a rare travel-related health problem of immunosuppressed returnees from endemic regions.
METHODS
We describe the case of a 68-year-old man with rheumatoid arthritis and tumor necrosis factor alpha (TNF-α) inhibitor treatment-related immunodeficiency, who suffered from disseminated histoplasmosis after traveling to Brazil. Based on this case, we discuss challenges and pitfalls associated with the diagnosis of disseminated histoplasmosis in a non-endemic setting.
RESULTS
The disease mimicked a hemophagocytic lymphohistiocytosis (HLH) like syndrome. Histoplasma capsulatum was microscopically detected in bronchoalveolar fluid and bone marrow aspirate smears, but was initially misclassified as Leishmania spp., another class of pathogens, which may cause HLH like syndromes in immunocompromised individuals.
DISCUSSION
Since the clinical symptoms of histoplasmosis are nonspecific and physicians in non-endemic regions might not be familiar with this disease pattern, there is a risk of delayed diagnosis of travel related cases. Taking a thorough travel history is key in unclear cases of illness in immunocompromised patients.
Actions (login required)
 |
Edit item |