SHM Converge Scientific Abstract ePoster Gallery-Histoplasma Prostatitis

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This case describes a 54-year-old man with advanced HIV infection (CD4 count 39) who presented with 3 weeks of progressive lower abdominal pain, nausea, chills, and weight loss. He had been off antiretroviral therapy for 3 years and had no urinary symptoms, diarrhea, or recent sexual activity. On exam, he was tachycardic and had oral thrush and an enlarged, non-tender prostate.<br /><br />Initial workup suggested a prostatic abscess, so he was started on vancomycin, cefepime, and metronidazole. However, his fevers and myalgias persisted, and urine and blood cultures were negative. CT imaging showed a hypodense lesion in the prostate. Transurethral procedures produced minimal purulent drainage. On hospital day 6, prostate tissue stained with Grocott Methenamine Silver revealed Histoplasma capsulatum, and urine antigen testing was positive. CT chest showed only small bilateral centrilobular nodules.<br /><br />The patient was diagnosed with histoplasmosis prostatitis, a very rare manifestation of disseminated histoplasmosis, with fewer than 12 cases reported in the literature, mostly in patients with AIDS. Histoplasma capsulatum is a dimorphic fungus endemic to North and Central America, and its geographic range is broader than traditionally recognized, now including much of the central and eastern United States. The organism spreads hematogenously, especially in immunocompromised hosts.<br /><br />After the diagnosis, antibiotics were stopped and treatment was changed to amphotericin B followed by itraconazole for one year. His fever and symptoms resolved rapidly after antifungal therapy began.<br /><br />The key takeaway is that persistent “prostatic abscess” symptoms without bacterial growth or response to antibiotics should prompt consideration of fungal causes, especially endemic mycoses such as Histoplasma in immunocompromised patients or those from endemic regions.

Asset Subtitle

Emily H. Wang

Meta Tag

Author List Emily H. Wang, Fabrizio Canepa Escaro, Hannah Smati

Category Clinical Vignettes

Concept Histoplasma Organism

Concept Histoplasmosis

Concept Disseminated Histoplasmosis

Concept Extrapulmonary Manifestation

Concept Histopathology

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Emily H. Wang

Track Adult

Keywords

HIV

AIDS

histoplasmosis

Histoplasma capsulatum

prostatitis

prostatic abscess

fungal infection

immunocompromised

amphotericin B

itraconazole

Histoplasma Organism

Histoplasmosis

Disseminated Histoplasmosis

Extrapulmonary Manifestation

Histopathology