SHM Converge Scientific Abstract ePoster Gallery-Atypical Presentation of Disseminated Histoplasmosis

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This case report describes a 54-year-old man with advanced AIDS in New York who presented with weakness, shortness of breath, hypotension, tachycardia, and tachypnea. He had diffuse cervical, inguinal, and popliteal lymphadenopathy, a very low CD4 count (1%), and a high HIV viral load. Echocardiography showed a moderate pericardial effusion, and he required emergent pericardiocentesis for tamponade-like hemodynamic compromise. His respiratory symptoms improved after drainage, and the effusion was initially thought to be AIDS-related.<br /><br />Because of the widespread lymphadenopathy, clinicians tested urine Histoplasma antigen, which was strongly positive, leading to the diagnosis of disseminated histoplasmosis. He was treated with itraconazole and colchicine.<br /><br />The report emphasizes that histoplasmosis is an underdiagnosed fungal infection that can mimic bacterial or viral pneumonia and may disseminate in immunocompromised patients, especially those with advanced HIV. While pulmonary disease is the most common presentation, pericardial involvement is rare. The case is notable because the patient denied travel outside New York, highlighting the northward geographic expansion of histoplasmosis in areas previously considered non-endemic.<br /><br />The authors note that urine Histoplasma antigen is the most sensitive test for disseminated disease, particularly in patients with HIV. They stress the importance of considering histoplasmosis in immunocompromised patients with unexplained pericardial effusion or tamponade, even in non-endemic regions. Early recognition and treatment are crucial because recurrent disseminated histoplasmosis-related pericardial effusion is uncommon but potentially life-threatening.

Asset Subtitle

Shwe Synn

Meta Tag

Author List Abhishek Sharma, Shwe Synn, Zahra Nasiriavanaki

Category Clinical Vignettes

Concept Histoplasmosis

Concept Histoplasma Antigen Test

Concept Disseminated Disease

Concept Itraconazole

Concept Fungal infection

Distinguished Non-Finalist

Presenter Organization Montefiore Medical Center

Presenting Author Shwe Synn

Track Adult

Keywords

advanced AIDS

disseminated histoplasmosis

pericardial effusion

cardiac tamponade

Histoplasma antigen

HIV infection

immunocompromised patient

lymphadenopathy

itraconazole

non-endemic region

Histoplasmosis

Histoplasma Antigen Test

Disseminated Disease

Itraconazole

Fungal infection