SHM Converge Scientific Abstract ePoster Gallery-Persistent Fevers, Immunodeficiency, and Travel History, Oh My!

Pdf Summary

A 19-month-old girl with an unspecified T-cell immunodeficiency presented with 10 days of cough, fatigue, and persistent fevers after returning from Mexico, where she had been diagnosed with influenza. She had stopped taking Bactrim prophylaxis for about 6 months. On admission she was febrile, tired, dehydrated, and required nasal cannula oxygen. Laboratory studies showed pancytopenia, marked transaminitis, and elevated inflammatory markers. Imaging initially showed no pneumonia, but repeat chest x-ray and CT later revealed a right pleural effusion, patchy lung opacities, and mild bilateral perihilar lymphadenopathy.<br /><br />Because of her immunodeficiency and persistent fever, clinicians pursued a broad infectious and malignancy workup, including testing for tuberculosis, HIV, fungal infections, viral pathogens, and hematologic disease. CSF studies, bone marrow aspirate, and bronchoalveolar lavage were also unrevealing. Ultimately, serum Histoplasma IgM/IgG and urine Histoplasma antigen were positive, confirming disseminated histoplasmosis. She was started on amphotericin B and itraconazole.<br /><br />The discussion highlights that disseminated histoplasmosis is uncommon in children but is more likely in immunocompromised patients, especially those with primary immunodeficiency. Symptoms are often nonspecific, commonly including fever, cough, weight loss, lymphadenopathy, hepatosplenomegaly, and pancytopenia, which can make diagnosis difficult. The case emphasizes that histoplasmosis should remain high on the differential in a child with persistent fevers, immunodeficiency, and travel to an endemic area, even when the physical exam is not striking.

Asset Subtitle

Roma Bhandarkar

Meta Tag

Author List Alexis Contreras, Roma Bhandarkar, Sheela Gavvala

Category Clinical Vignettes

Concept Disseminated Histoplasmosis

Concept Fever

Concept Amphotericin B

Concept Persistent Fever

Concept Immunocompromised State

Distinguished Finalist

Presenter Organization UT Health Houston

Presenting Author Roma Bhandarkar

Track Pediatric

Keywords

disseminated histoplasmosis

T-cell immunodeficiency

pancytopenia

persistent fever

immunocompromised child

Mexico travel

Histoplasma antigen

amphotericin B

itraconazole

pulmonary opacities

Disseminated Histoplasmosis

Fever

Amphotericin B

Persistent Fever

Immunocompromised State