Disseminated histoplasmosis diagnosed in a bone marrow sample

Mussá, Naseelah Yunus; Ismail, Sara; Carvalho, Dinah

doi:10.1016/j.htct.2020.10.960

Histoplasmosis is a fungal infection caused by a dimorphic fungus Histoplasma capsulatum.¹ Progressive disseminated histoplasmosis (PDH) is an AIDS-defining illness with a high lethality rate if not promptly treated.³ In patients with disseminated disease, culture and pathology are the most sensitive.² The gold standard for the identification of the pathogen is the culture demonstrating the thermal dimorphism of the fungus.³ We present a case of a 52 year old male with HIV-1 infection (CDC-C3) and a recent trip to Brasil, admitted in the ICU with a diagnosis of Pneumocystis jirovecii pneumonia (under co-trimoxazole treatment) and haemophagocytic lymphohistiocytosis. A bone marrow (BM) aspirate was performed and stained May-Grunwald-Giemsa films revealed numerous yeast-like bodies inside and outside macrophages with morphology suggestive of Histoplasma spp (Figure 1, Figure 2). Culture and molecular results (bone marrow PCR) confirmed the microbiological diagnosis- Histoplasma capsulatum.

Figure 1
BM aspirate: numerous yeast-like bodies inside macrophages (arrows) with morphology suggestive of Histoplasma spp.

Figure 2
BM aspirate: yeast-like bodies outside macrophages (arrow) with morphology suggestive of Histoplasma spp.

References

¹ Fakhfakh N, Abdelmlak R, Aissa S, Kallel A, Boudawara Y, Bel Hadj S, et al. Disseminated histoplasmosis diagnosed in the bone marrow of an HIV-infected patient: First case imported in Tunisia. J Mycol Med. 2018;28(1):211-4.
² Hill Ev, Cavuoti D, Luu Hs, McElvania TeKippe E. The Brief Case: Disseminated Histoplasma capsulatum in a Patient with Newly Diagnosed HIV Infection/AIDS. J Clin Microbiol. 2018;56(Feb (3)):e00905-17.
³ Zanotti P, Chirico C, Gulletta M, Ardighieri L, Casari S, Roldan EQ, et al. Disseminated Histoplasmosis as AIDS-presentation. Case Report and Comprehensive Review of Current Literature. Mediterr J Hematol Infect Dis. 2018;10(1):e2018040.

Publication Dates

Publication in this collection
21 Mar 2022
Date of issue
Jan-Mar 2022

History

Received
11 Sept 2020
Accepted
02 Oct 2020
Published
04 Dec 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

[1] ¹ Fakhfakh N, Abdelmlak R, Aissa S, Kallel A, Boudawara Y, Bel Hadj S, et al. Disseminated histoplasmosis diagnosed in the bone marrow of an HIV-infected patient: First case imported in Tunisia. J Mycol Med. 2018;28(1):211-4.

[2] ² Hill Ev, Cavuoti D, Luu Hs, McElvania TeKippe E. The Brief Case: Disseminated Histoplasma capsulatum in a Patient with Newly Diagnosed HIV Infection/AIDS. J Clin Microbiol. 2018;56(Feb (3)):e00905-17.

[3] ³ Zanotti P, Chirico C, Gulletta M, Ardighieri L, Casari S, Roldan EQ, et al. Disseminated Histoplasmosis as AIDS-presentation. Case Report and Comprehensive Review of Current Literature. Mediterr J Hematol Infect Dis. 2018;10(1):e2018040.