Yonsei Med J.  2007 Jun;48(3):531-534. 10.3349/ymj.2007.48.3.531.

Disseminated Histoplasmosis and Tuberculosis in a Patient with HIV Infection

• Jeong HW
• Sohn JW
• Kim MJ
• Choi JW
• Kim CH
• Choi SH
• Kim J
• Cho Y

• KMID: 724111
• DOI: http://doi.org/10.3349/ymj.2007.48.3.531

Abstract

Histoplasmosis is a very rare disease in Korea. Clinical manifestations are very similar to those of tuberculosis. This is the first case report of combined disseminated histoplasmosis and tuberculosis in a patient with HIV infection in Korea. A 42-year-old Korean with Acquired Immunodeficiency Syndrome (AIDS) was diagnosed with tuberculosis. He had lived in Guatemala for the past five years. Upon diagnosis of disseminated tuberculosis with HIV infection, he was treated with anti-tuberculosis medications and anti-retroviral agents. Fever, weakness, hepatosplenomegaly and pancytopenia were persistent despite treatment. The patient's history of living in Guatemala caused us to seek opportunistic infectious organisms other than tuberculosis. Bone marrow aspiration and biopsy were performed and the result revealed numerous intracellular organisms consistent with Histoplasma capsulatum; therefore, the diagnosis of disseminated histoplasmosis was made.

MeSH Terms

AIDS-Related Opportunistic Infections/microbiology
Acquired Immunodeficiency Syndrome/complications/pathology
Adult
Bone Marrow/microbiology/pathology
HIV Infections/*complications/drug therapy
Histoplasma/isolation & purification
Histoplasmosis/complications/*diagnosis/microbiology
Humans
Male
Thorax/microbiology/pathology/radionuclide imaging
Tuberculosis/complications/*diagnosis

Figure

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  Fig. 1 Chest X-ray. (A) Chest PA, (B) Chest right decubitus view- Right side pleural effusion and mild peribronchial infiltrations are seen.

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  Fig. 2 Bone marrow aspirates and biopsies. (A) Bone marrow aspirate, Wright-Giemsa stain × 1000. Numerous intracellular Histoplasma capsulatum are seen in several histiocytes. (B) Bone marrow biopsy, H & E stain × 100. The bone marrow is hypercellular and is packed with macrophages and eosinophils. The number of normal hematopoietic elements is markedly decreased. (C) Bone marrow biopsy, H & E stain × 1000. At high magnification, the infiltrate consists of macrophages which contain small, oval yeasts within their cytoplasm. A single nuclear mass can be seen in most yeast cells. (D) Bone narrow biopsy, PAS stain × 1000. The small yeasts are well demonstrated by PAS stain, which highlights the single nuclear body. The intracellular location of the yeast is clarified by clustering.

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