Image in medicine
Disseminated histoplasmosis in immunosuppressed patient
Histoplasmosis diseminada en paciente inmunosuprimido
Horacio Matías Castro
, Martin Pablo Fullana, Hernán Luis Canale
Corresponding author
Sección de Neumonologia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Upon admission, he was suffering from respiratory failure. A chest computed tomography showed subpleural, fissural and centrilobular micronodular lesions of diffuse distribution (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>1A, arrow), and a lung cavitation of 15<span class="elsevierStyleHsp" style=""></span>mm in diameter, located in the medial segment of the right lower lobe (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B, arrow). A fiberoptic bronchoscopy with bronchoalveolar lavage was performed, showing intracellular yeasts in Grocott's methenamine silver stain, and a <span class="elsevierStyleItalic">Histoplasma capsulatum</span> was isolated in the mycological study. The diagnosis of disseminated histoplasmosis was established. The patient was treated with amphotericin B followed by itraconazole, with a favorable clinical progression. Disseminated histoplasmosis is an infection caused by <span class="elsevierStyleItalic">H. capsulatum</span> which occurs primarily in immunocompromised patients. The use of glucocorticoids and immunosuppressive agents after organ transplantation compromise T-cell immunity, predisposing to disseminated forms of histoplasmosis. The most common radiological finding is the presence of multiple small nodular opacities, smaller than 3<span class="elsevierStyleHsp" style=""></span>mm in diameter and diffuse in distribution. This tomographic pattern can be found in miliary tuberculosis or in hematogenous metastases. Treatment includes administration of amphotericin B for 2 weeks, followed by itraconazole for 12 months.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Castro HM, Fullana MP, Canale HL, . Histoplasmosis diseminada en paciente inmunosuprimido. Med Clin (Barc). 2020;156:48.</p>" ] ] "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "pl1.jpeg" "Alto" => 579 "Ancho" => 1250 "Tamanyo" => 162814 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015600000001/v1_202101070942/S2387020620305945/v1_202101070942/en/main.assets" "Apartado" => array:4 [ "identificador" => "51820" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015600000001/v1_202101070942/S2387020620305945/v1_202101070942/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620305945?idApp=UINPBA00004N" ]
