Travel related histoplasmosis - a diagnostic challenge in a patient with tumor necrosis factor alpha (TNF-α) inhibitor therapy.

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

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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.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology
04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Haematology and Central Haematological Laboratory
04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases > Clinical Microbiology

UniBE Contributor:

Hofmann, Eveline; Mühlethaler, Konrad; Pollak, Matthias; Ott, Daniel; Bienz, Nora; Zimmerli, Stefan and Hirzel, Cédric

Subjects:

600 Technology > 610 Medicine & health
500 Science > 570 Life sciences; biology

ISSN:

2055-0936

Publisher:

BioMed Central

Language:

English

Submitter:

Pubmed Import

Date Deposited:

20 Sep 2022 15:27

Last Modified:

20 Sep 2022 15:36

Publisher DOI:

10.1186/s40794-022-00178-2

PubMed ID:

36104715

Uncontrolled Keywords:

Hemophagocytic lymphohistiocytosis Histoplasmosis Immunocompromised Returning traveler TNF-α inhibitor

BORIS DOI:

10.48350/173054

URI:

https://boris.unibe.ch/id/eprint/173054

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