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

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A 19-month-old girl with an unspecified T-cell immunodeficiency presented with 10 days of cough, fatigue, and persistent fever after returning from Mexico, where she had been diagnosed with influenza. She had stopped Bactrim prophylaxis for about 6 months. On admission, she appeared tired and dehydrated, required supplemental oxygen, and had diffuse crackles. Labs showed pancytopenia, marked transaminitis, and elevated inflammatory markers.<br /><br />Initial chest X-ray was unrevealing, but repeat imaging later showed a right basilar opacity. CT of the chest, abdomen, and pelvis revealed a small right pleural effusion, patchy right middle lobe and lingular opacities, and mild bilateral hilar/perihilar lymphadenopathy. An extensive infectious and malignancy workup was performed, including testing for tuberculosis, HIV, fungal infections, viral infections, parasites, and evaluations of CSF, bone marrow, and bronchoalveolar lavage; all were negative. However, serum Histoplasma IgM and IgG and urine Histoplasma antigen were positive, confirming disseminated histoplasmosis. She was started on amphotericin B and itraconazole.<br /><br />The discussion emphasizes that disseminated histoplasmosis is rare in children but is more likely in immunocompromised patients, especially those with primary immunodeficiencies. Presentation is often nonspecific, with fever, cough, weight loss, lymphadenopathy, hepatosplenomegaly, and pancytopenia. In immunosuppressed children with persistent fever, the differential is broad and includes tuberculosis, malignancy, HLH, PCP, and other fungal infections. Histoplasmosis should be considered particularly in patients with travel to endemic regions and underlying T-cell immunodeficiency.

Asset Subtitle

Roma Bhandarkar

Meta Tag

Author List Alexis Contreras, Roma Bhandarkar, Sheela Gavvala

Category Clinical Vignettes

Concept Disseminated Histoplasmosis

Concept Immunocompromised child

Concept T-cell Immunodeficiency

Concept Amphotericin B

Concept Itraconazole

Distinguished Non-Finalist

Presenter Organization UT Health Houston

Presenting Author Roma Bhandarkar

Track Pediatric

Keywords

disseminated histoplasmosis

T-cell immunodeficiency

pancytopenia

persistent fever

histoplasma antigen

amphotericin B

itraconazole

immunocompromised child

travel to Mexico

fungal infection

Disseminated Histoplasmosis

Immunocompromised child

T-cell Immunodeficiency

Amphotericin B

Itraconazole