SHM Converge Scientific Abstract ePoster Gallery-An Immunocompetent Patient With Disseminated Histoplasmosis

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A 68-year-old man from Ohio with chronic kidney disease and MGUS presented with 6 months of weakness and unintentional weight loss. His prior workup suggested a plasma cell disorder, including Bence Jones proteinuria, monoclonal bands on serum and urine testing, a right tibial lytic lesion, hypercalcemia, coagulopathy, pancytopenia, and splenic infarcts. CT of the chest showed ground-glass opacities, and because of clinical decline, a bone marrow biopsy was performed.<br /><br />Bone marrow biopsy did not show plasma cell dyscrasia but instead raised concern for disseminated histoplasmosis. Although bronchoscopy was negative, additional testing supported the diagnosis: Fungitell was positive, Histoplasma serologies were strongly positive, and immunodiffusion showed both H and M bands. Lumbar puncture was negative for CNS involvement. The patient was treated with liposomal amphotericin B followed by prolonged posaconazole.<br /><br />Histoplasma capsulatum is the most common endemic fungal infection in the United States. Disseminated disease in immunocompetent patients is uncommon, usually affects older adults, and may present with pancytopenia, hepatosplenomegaly, lymphadenopathy, and a prolonged, nonspecific illness. In this case, the presentation initially mimicked progression of MGUS to multiple myeloma, but the true diagnosis was disseminated histoplasmosis.<br /><br />This case emphasizes that disseminated histoplasmosis should remain on the differential diagnosis even in immunocompetent hosts, especially when findings resemble malignancy. Early recognition and treatment can improve outcomes.

Asset Subtitle

Pavithra Kannan

Meta Tag

Author List George Kallingal, Jay Anderson, John Weis, Pavithra Kannan

Category Clinical Vignettes

Concept Histoplasmosis

Concept Liposomal Amphotericin B

Concept Pancytopenia

Concept Bone Marrow Biopsy

Concept Azole Therapy

Distinguished Non-Finalist

Presenter Organization OhioHealth Riverside Methodist Hospital - Columbus, OH

Presenting Author Pavithra Kannan

Track Adult

Keywords

disseminated histoplasmosis

Histoplasma capsulatum

MGUS

multiple myeloma mimic

bone marrow biopsy

pancytopenia

Bence Jones proteinuria

lytic bone lesion

liposomal amphotericin B

posaconazole

Histoplasmosis

Liposomal Amphotericin B

Pancytopenia

Bone Marrow Biopsy

Azole Therapy