TY - JOUR
T1 - Disseminated histoplasmosis and hemophagocytic lymphohistiocytosis in a patient receiving TNF-alpha inhibitor therapy
AU - Zhong, Qiaonan
AU - Ordaya, Eloy E.
AU - Fernandez, Santiago Delgado
AU - Lescalleet, Kristin
AU - Larson, Daniel
AU - Pritt, Bobbi
AU - Berbari, Elie
N1 - Publisher Copyright:
© 2022
PY - 2022/1
Y1 - 2022/1
N2 - Histoplasmosis commonly presents as an asymptomatic or self-limited infection in immunocompetent patients, but immunocompromised hosts may present with severe and disseminated disease. Herein, we present a 26-year-old male with history of ulcerative colitis receiving long-term TNF-alpha inhibitor therapy who presented with six months of diarrhea and recently fever and hematochezia. On admission, he was febrile and hypotensive, with initial workup revealing pancytopenia and imaging reporting pulmonary infiltrates, pancolitis, and enlarged mesenteric lymph nodes. Disseminated histoplasmosis was ultimately diagnosed after examination of the colonic biopsy. Bone marrow biopsy was also consistent with the diagnosis of histoplasmosis but also demonstrated hemophagocytic lymphohistiocytosis. The patient was ultimately treated with amphotericin B, intravenous immunoglobulin, etoposide, and corticosteroids.
AB - Histoplasmosis commonly presents as an asymptomatic or self-limited infection in immunocompetent patients, but immunocompromised hosts may present with severe and disseminated disease. Herein, we present a 26-year-old male with history of ulcerative colitis receiving long-term TNF-alpha inhibitor therapy who presented with six months of diarrhea and recently fever and hematochezia. On admission, he was febrile and hypotensive, with initial workup revealing pancytopenia and imaging reporting pulmonary infiltrates, pancolitis, and enlarged mesenteric lymph nodes. Disseminated histoplasmosis was ultimately diagnosed after examination of the colonic biopsy. Bone marrow biopsy was also consistent with the diagnosis of histoplasmosis but also demonstrated hemophagocytic lymphohistiocytosis. The patient was ultimately treated with amphotericin B, intravenous immunoglobulin, etoposide, and corticosteroids.
KW - Disseminated histoplasmosis
KW - Hemophagocytic lymphohistiocytosis
KW - TNF-alpha inhibitor
KW - Ulcerative colitis
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U2 - 10.1016/j.idcr.2022.e01603
DO - 10.1016/j.idcr.2022.e01603
M3 - Article
AN - SCOPUS:85136185300
SN - 2214-2509
VL - 29
JO - IDCases
JF - IDCases
M1 - e01603
ER -