The intricate relationship of histoplasmosis and sarcoidosis: A case report

Poonam Mathur, John Zurlo, Tonya Crook

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction. Histoplasmosis is an endemic mycosis with most cases of clinical illness reported in North and Central America. Rarely, patients develop progressive disseminated histoplasmosis with extrapulmonary manifestations. These infections are fatal if not appropriately treated. Case presentation. We report a case of progressive disseminated histoplasmosis presenting with fever, progressive dyspnea, and pancytopenia in a 51-year-old Caucasian man who had been treated with chronic steroids for a diagnosis of sarcoidosis made 20 years previously. His presentation was initially mistaken for sarcoidosis but, fortunately, laboratory results showed hematologic abnormalities, and the diagnosis of histoplasmosis was made by bone marrow biopsy. Conclusions: Sarcoidosis reduces T cell activity, and the addition of steroids for treatment causes further immunosuppression and vulnerability for development of a disseminated infection. The diagnosis of histoplasmosis depends mainly on clinical presentation and host factors. Although there are diagnostic laboratory tests available, clinicians may need to diagnose histoplasmosis by history and physical examination alone and treat empirically, since awaiting Histoplasma-specific laboratory results would delay initiation of treatment. Primary care providers, hospitalists, and subspecialists alike should be aware of the overlap in clinical and radiological presentations of sarcoidosis and histoplasmosis, and when and how to pursue diagnostic testing for endemic mycoses, since these infections can be fatal in immunosuppressed patients without appropriate treatment.

Original languageEnglish (US)
Article number235
JournalJournal of Medical Case Reports
Volume8
Issue number1
DOIs
StatePublished - Jun 27 2014

Fingerprint

Histoplasmosis
Sarcoidosis
Mycoses
Infection
Steroids
Hospitalists
Histoplasma
Central America
Pancytopenia
North America
Routine Diagnostic Tests
Dyspnea
Immunosuppression
Physical Examination
Primary Health Care
Fever
Therapeutics
Bone Marrow
History
T-Lymphocytes

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

@article{a20f68b03e3f4e848233ebe0177ae36a,
title = "The intricate relationship of histoplasmosis and sarcoidosis: A case report",
abstract = "Introduction. Histoplasmosis is an endemic mycosis with most cases of clinical illness reported in North and Central America. Rarely, patients develop progressive disseminated histoplasmosis with extrapulmonary manifestations. These infections are fatal if not appropriately treated. Case presentation. We report a case of progressive disseminated histoplasmosis presenting with fever, progressive dyspnea, and pancytopenia in a 51-year-old Caucasian man who had been treated with chronic steroids for a diagnosis of sarcoidosis made 20 years previously. His presentation was initially mistaken for sarcoidosis but, fortunately, laboratory results showed hematologic abnormalities, and the diagnosis of histoplasmosis was made by bone marrow biopsy. Conclusions: Sarcoidosis reduces T cell activity, and the addition of steroids for treatment causes further immunosuppression and vulnerability for development of a disseminated infection. The diagnosis of histoplasmosis depends mainly on clinical presentation and host factors. Although there are diagnostic laboratory tests available, clinicians may need to diagnose histoplasmosis by history and physical examination alone and treat empirically, since awaiting Histoplasma-specific laboratory results would delay initiation of treatment. Primary care providers, hospitalists, and subspecialists alike should be aware of the overlap in clinical and radiological presentations of sarcoidosis and histoplasmosis, and when and how to pursue diagnostic testing for endemic mycoses, since these infections can be fatal in immunosuppressed patients without appropriate treatment.",
author = "Poonam Mathur and John Zurlo and Tonya Crook",
year = "2014",
month = "6",
day = "27",
doi = "10.1186/1752-1947-8-235",
language = "English (US)",
volume = "8",
journal = "Journal of Medical Case Reports",
issn = "1752-1947",
publisher = "BioMed Central",
number = "1",

}

The intricate relationship of histoplasmosis and sarcoidosis : A case report. / Mathur, Poonam; Zurlo, John; Crook, Tonya.

In: Journal of Medical Case Reports, Vol. 8, No. 1, 235, 27.06.2014.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The intricate relationship of histoplasmosis and sarcoidosis

T2 - A case report

AU - Mathur, Poonam

AU - Zurlo, John

AU - Crook, Tonya

PY - 2014/6/27

Y1 - 2014/6/27

N2 - Introduction. Histoplasmosis is an endemic mycosis with most cases of clinical illness reported in North and Central America. Rarely, patients develop progressive disseminated histoplasmosis with extrapulmonary manifestations. These infections are fatal if not appropriately treated. Case presentation. We report a case of progressive disseminated histoplasmosis presenting with fever, progressive dyspnea, and pancytopenia in a 51-year-old Caucasian man who had been treated with chronic steroids for a diagnosis of sarcoidosis made 20 years previously. His presentation was initially mistaken for sarcoidosis but, fortunately, laboratory results showed hematologic abnormalities, and the diagnosis of histoplasmosis was made by bone marrow biopsy. Conclusions: Sarcoidosis reduces T cell activity, and the addition of steroids for treatment causes further immunosuppression and vulnerability for development of a disseminated infection. The diagnosis of histoplasmosis depends mainly on clinical presentation and host factors. Although there are diagnostic laboratory tests available, clinicians may need to diagnose histoplasmosis by history and physical examination alone and treat empirically, since awaiting Histoplasma-specific laboratory results would delay initiation of treatment. Primary care providers, hospitalists, and subspecialists alike should be aware of the overlap in clinical and radiological presentations of sarcoidosis and histoplasmosis, and when and how to pursue diagnostic testing for endemic mycoses, since these infections can be fatal in immunosuppressed patients without appropriate treatment.

AB - Introduction. Histoplasmosis is an endemic mycosis with most cases of clinical illness reported in North and Central America. Rarely, patients develop progressive disseminated histoplasmosis with extrapulmonary manifestations. These infections are fatal if not appropriately treated. Case presentation. We report a case of progressive disseminated histoplasmosis presenting with fever, progressive dyspnea, and pancytopenia in a 51-year-old Caucasian man who had been treated with chronic steroids for a diagnosis of sarcoidosis made 20 years previously. His presentation was initially mistaken for sarcoidosis but, fortunately, laboratory results showed hematologic abnormalities, and the diagnosis of histoplasmosis was made by bone marrow biopsy. Conclusions: Sarcoidosis reduces T cell activity, and the addition of steroids for treatment causes further immunosuppression and vulnerability for development of a disseminated infection. The diagnosis of histoplasmosis depends mainly on clinical presentation and host factors. Although there are diagnostic laboratory tests available, clinicians may need to diagnose histoplasmosis by history and physical examination alone and treat empirically, since awaiting Histoplasma-specific laboratory results would delay initiation of treatment. Primary care providers, hospitalists, and subspecialists alike should be aware of the overlap in clinical and radiological presentations of sarcoidosis and histoplasmosis, and when and how to pursue diagnostic testing for endemic mycoses, since these infections can be fatal in immunosuppressed patients without appropriate treatment.

UR - http://www.scopus.com/inward/record.url?scp=84902893075&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84902893075&partnerID=8YFLogxK

U2 - 10.1186/1752-1947-8-235

DO - 10.1186/1752-1947-8-235

M3 - Article

C2 - 24972490

AN - SCOPUS:84902893075

VL - 8

JO - Journal of Medical Case Reports

JF - Journal of Medical Case Reports

SN - 1752-1947

IS - 1

M1 - 235

ER -