Histoplasmosis in Patient with 23 Years Untreated HIV/AIDS

Abstract

This case report describes disseminated histoplasmosis in a 43-year-old African American woman who had been told she had HIV in 2002, during her only pregnancy, but never received treatment or follow-up because of fear of stigmatization and of possible harm to her unborn child. She presented in the outpatient setting with three weeks of chills, malaise, body aches, decreased appetite, weight loss, nausea, fever and diarrhea, with an HIV viral load of 327,000 vc/ml and a CD4 count of 8 cell/cmm. Computerized tomography of the abdomen showed enteritis and enlarged mesenteric and retroperitoneal lymph nodes, and CT-guided biopsy of a retroperitoneal lymph node showed caseating granuloma with intracellular fungal organisms most consistent with Histoplasma, with no malignancy. Given gastrointestinal and reticuloendothelial involvement, she was diagnosed with disseminated histoplasmosis and treated with intravenous amphotericin B followed by oral itraconazole for twelve months, alongside bictegravir-emtricitabine-tenofovir alafenamide and sulfamethoxazole-trimethoprim. After discharge she remained compliant, her viral load fell to 50 vc/ml, her CD4 count rose to 166 cell/cmm, and she returned to work. The authors conclude that her untreated HIV most likely led to the disseminated histoplasmosis, and that the case highlights the need to link every patient diagnosed with HIV to care, to destigmatize HIV treatment, and to provide less stigmatizing and more accessible offices for HIV care.

Abstract prepared by the editorial office from the full text of the article; the authors did not supply one.