A case report of progressive disseminated histoplasmosis in Vietnam

 https://doi.org/10.52322/jocmbmh.08.en.05

Introduction: Histoplasma capsulatum is a thermally dimorphic fungus, mainly lives in the central and eastern states, especially areas around the Ohio and Mississippi River valleys.

Objectives: We aim to describe a rare case report of progressive disseminated histoplasmosis in Vietnam.

Case presenttation: A 55-year-old man with high fever and swelling left arm for 4 months was admitted to the hospital with pancytopenia, hepatosplenomegaly and axilarry large abcesses. He had history of psoriasis that he was used intramuscular injection with unknown drug on the left arm once a month permanently. He had received therapy with many antibiotics (Vancomycin, Ceftazidim, Cefazolin, Meropenem) that can cover almost the entire etiology of bacteria (Gram possitive, Gram negative, anaerobic bacteria) but no responded. All initial cultures results were negative but bone marrow biopsy showed image of invasive Histoplasma. Antifungal therapy was started, CVVH was taken, abcess was drainaged and the patient responded well to ABLC. Abcess culture was positive to Histoplasma capsulatum after 15 days. Unfortunately, the patient was too exhausted after a long illness and died of nosocomial infection.

Conclusion: This is the first case of progressive disseminated histoplasmosis that has been reported in Vietnam. Screening active fungal in immunocompromised patient, especially prolonged use of corticosteroids; looking for histopathological evidence that diagnosis and treatment early is important to clinician.

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