scholarly journals Hemophagocytic Lymphohistiocytosis (HLH) in a Patient with Disseminated Histoplasmosis

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Neeraja Swaminathan ◽  
Jorge M. Vinicius ◽  
Jesse Serrins
Keyword(s):  
Antifungal Therapy ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Histoplasma Capsulatum ◽  
Interleukin 1 ◽  
Clinical Manifestations ◽  
Rare Condition ◽  
Genetic Mutation ◽  
Rapid Progression ◽  
Disseminated Histoplasmosis

Hemophagocytic lymphohistiocytosis (HLH) is a rare condition characterized by an overwhelming inflammatory cascade activation which is often associated with rapid progression and high mortality. It may be familial with an underlying genetic mutation or triggered by infection, malignancy, and autoimmune disease. Disseminated histoplasmosis caused by histoplasma capsulatum is a granulomatous fungal disease seen typically in immunocompromised patients with varied clinical manifestations and requires long-term antifungal therapy. We present the case of a 61-year-old immunocompromised female with significant travel history who came with fever, pancytopenia, and liver failure raising suspicion for HLH that prompted a bone marrow biopsy procedure. Hemophagocytic figures consistent with HLH and numerous encapsulated fungi resembling histoplasma were visualized. She was treated with intravenous (IV) liposomal amphotericin B. Etoposide chemotherapy and interleukin-1 (IL-1) antagonist anakinra were deferred in order to limit her immunosuppression, and treatment was focused on antifungal therapy.

scholarly journals A Case of Hemophagocytic Lymphohistiocytosis Secondary to Disseminated Histoplasmosis

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Ivan Columbus-Morales ◽  
Lucas Maahs ◽  
Sanam Husain ◽  
Stuart C. Gordon ◽  
Kedar V. Inamdar ◽  
...  
Keyword(s):  
Liver Function ◽  
Autoimmune Diseases ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Immunocompromised Patient ◽  
Multiorgan Failure ◽  
Clinical Manifestations ◽  
Rare Condition ◽  
Immune Dysregulation ◽  
Multiorgan Dysfunction ◽  
Disseminated Histoplasmosis

Hemophagocytic lymphohistiocytosis (HLH) is a rare condition characterized by a pathologic immune dysregulation resulting in extreme inflammation. Clinical manifestations are varied but can include severe multiorgan failure and death. HLH has been associated with malignancies, autoimmune diseases, and infections, such as histoplasmosis. Histoplasmosis commonly has subclinical manifestations but can also present in its disseminated form. We present the case of an immunocompromised patient with worsening liver function caused by hepatic histoplasmosis that later triggered HLH with severe multiorgan dysfunction.

scholarly journals Hemophagocytic Lymphohistiocytosis Secondary to Disseminated Histoplasmosis in Rheumatologic Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Yael Kusne ◽  
Michael Christiansen ◽  
Christopher Conley ◽  
Juan Gea-Banacloche ◽  
Ayan Sen
Keyword(s):  
Hemophagocytic Lymphohistiocytosis ◽  
Pediatric Patients ◽  
Histoplasma Capsulatum ◽  
Hematologic Malignancies ◽  
Rapid Diagnosis ◽  
Rheumatologic Disease ◽  
Disseminated Histoplasmosis ◽  
Serious Infections ◽  
Time To Diagnosis ◽  
Prompt Diagnosis

Background. Hemophagocytic lymphohistiocytosis (HLH) was originally described in pediatric patients presenting with fever, hepatosplenomegaly, and blood cell abnormalities. Later, HLH was recognized to occur in adults, often associated with hematologic malignancies or serious infections. Conclusion. Patients presenting with HLH are critically ill, and rapid diagnosis is key. In adults, the search for the trigger must begin promptly as time to diagnosis effects survival. The underlying trigger in our patients was Histoplasma capsulatum infection, which is rare in the southwestern United States. Prompt diagnosis led to recovery in one patient, while the other did not survive.

scholarly journals SEPTIC SHOCK IN PATIENT WITH DISSEMINATED HISTOPLASMOSIS ASSOCIATED WITH AIDS: A CASE REPORT

2013 ◽  
Vol 55 (4) ◽  
pp. 283-286
Author(s):  
Fabiano de Oliveira Poswar ◽  
Jair Almeida Carneiro ◽  
Janice Mendes Stuart ◽  
Jorge Patrick Oliveira Feliciano ◽  
Daniella Cristina Nassau
Keyword(s):  
Septic Shock ◽  
Histoplasma Capsulatum ◽  
Peripheral Blood Smear ◽  
The Body ◽  
Rapid Progression ◽  
Newly Diagnosed ◽  
Systemic Mycosis ◽  
Disseminated Histoplasmosis ◽  
Serious Infection ◽  
History Of

SUMMARY Histoplasmosis is a systemic mycosis caused by Histoplasma capsulatum, which may present itself as a serious infection in immunocompromised individuals. We present a case of 31-year-old female with newly diagnosed HIV infection and history of fever, general and respiratory symptoms and diffuse hyperchromic papules through the body. She was admitted, with rapid progression to septic shock, and the presence of neutrophils filled with yeast-like organisms was detected on peripheral blood smear hematoscopia on the third day of hospitalization. The following is a brief review on the clinical picture and management of histoplasmosis.

scholarly journals Secondary Subcutaneous Rhizopus Infection in a Posttransplant Recipient with Calcific Uremic Arteriolopathy

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Urmila Anandh ◽  
Rakesh Kumar ◽  
Vishnu Rao
Keyword(s):  
Early Identification ◽  
Skin Necrosis ◽  
Renal Allograft ◽  
Clinical Manifestations ◽  
Rare Condition ◽  
Necrotic Lesion ◽  
Renal Allograft Recipient ◽  
Underlying Condition ◽  
Calcific Uremic Arteriolopathy

Calcific uremic arteriolopathy is a rare condition affecting chronic kidney disease (CKD) patients on long-term dialysis. The clinical manifestations include subcutaneous skin necrosis and ulcers secondary to calcification of the subcutaneous blood vessels. The necrotic tissue often becomes a nidus of infection. The prognosis is often poor. We present a case of a renal allograft recipient who developed a subcutaneous necrotic lesion which was subsequently infected by Rhizopus spp. The patient underwent surgical debridement and antifungal therapy. The infection resolved completely. Our case represents agrave underlying condition predisposing a rare and serious posttransplant infection. The outcome was favourable because of early identification and treatment of the infection.

scholarly journals Sump Syndrome: A Rare Long-Term Complication of Choledochoduodenostomy

2017 ◽  
Vol 11 (2) ◽  
pp. 428-433 ◽  
Author(s):  
Hrudya Abraham ◽  
Sajan Thomas ◽  
Amit Srivastava
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Clinical Manifestations ◽  
Rare Condition ◽  
Endoscopic Retrograde ◽  
Distal Common Bile Duct ◽  
History Of ◽  
The Common

Biliary sump syndrome is a rare condition. It is seen as a rare long-term complication in patients with a history of a side-to-side choledochoduodenostomy. In the era before endoscopic retrograde cholangiopancreatography, side-to-side choledochoduodenostomy was a common surgical procedure for the management of biliary obstruction. In the setting of a side-to-side choledochoduodenostomy, the bile does not drain through the distal common bile duct anymore. Therefore, the part of the common bile duct distal from the choledochoduodenostomy anastomosis consequently transforms into a poorly drained reservoir, making this so-called “sump” prone to accumulation of debris. These patients are prone to cholangitis. We present a 64-year-old man with a history of side-to-side choledochoduodenostomy who presented with manifestations of cholangitis. An endoscopic retrograde cholangiopancreatography confirmed a diagnosis of sump syndrome. The etiology, clinical manifestations, and treatment of biliary sump syndrome are discussed in this article.

scholarly journals Hilaiditi syndrome as a cause of chronic duodenal obstruction in children operated on for omphalocele

2021 ◽  
pp. 181-187
Author(s):  
A. Yu. Razumovskiy ◽  
N. V. Kulikova ◽  
V. V. Cholostova ◽  
M. A. Amanova ◽  
A. I. Khavkin
Keyword(s):  
Duodenal Obstruction ◽  
Neonatal Period ◽  
Clinical Manifestations ◽  
Rare Condition ◽  
Original Method ◽  
Leading Role ◽  
Abdominal Organs ◽  
Wide Range ◽  
Great Vessels

Introduction. Chilaiditi syndrome—hepatodiaphragmatic interposition—is a rare condition in which bowel loops are compressed in the space between the liver and the dome of the diaphragm, which can lead to the development of a wide range of complications. In the available literature data on the clinical manifestations of this condition in children with omphalocele are not described.Materials and methods. The article describes rare clinical cases of patients 1 year 1 month, 2 years 11 month and 12 years old, previously operated on in the neonatal period for omphalocele, in whom, in the long term after surgery, signs of hepatodiaphragmatic interposition persisted, which led to the development of chronic duodenal obstruction.Conclusion: It has been proven that the leading role in restoring the normal topography of the abdominal organs in children with omphalocele is played by the complete mobilization of the liver and the great vessels (IVC) fi xing it, which provide the possibility of its subphrenic localization. Chronic duodenal obstruction in children with a similar pathology has not been previously described. The proposed original method of surgical treatment seems to be pathogenetically justifi ed.

scholarly journals Evaluation of an enzyme-linked immunosorbent assay using purified, deglycosylated histoplasmin for different clinical manifestations of histoplasmosis

2010 ◽  
Vol 1 (1) ◽  
pp. 2 ◽  
Author(s):  
Allan Jefferson Guimaraes ◽  
Claudia Vera Pizzini ◽  
Marcos De Abreu Almeida ◽  
José Mauro Peralta ◽  
Joshua Daniel Nosanchuk ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Immunosorbent Assay ◽  
Histoplasma Capsulatum ◽  
Clinical Manifestations ◽  
Enzyme Linked Immunosorbent Assay ◽  
Humoral Immune ◽  
Disseminated Histoplasmosis ◽  
Test Specificity ◽  
Disseminated Disease ◽  
Further Development

Diagnosis of invasive fungal diseases remains problematic, especially in undeveloped countries. We have developed an enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies to Histoplasma capsulatum using metaperiodate treated purified histoplasmin (ptHMIN). Our ELISA was validated comparing sera from patients with histoplasmosis, related mycoses, and healthy individuals. The overall test specificity was 96%, with sensitivities of 100% (8/8) in acute disease, 90% (9/10) in chronic disease, 89% (8/9) in disseminated infection in individuals without HIV infection, 86% (12/14) in disseminated disease in the setting of HIV infection and 100% (3/3) in mediastinal histoplasmosis. These parameters are superior to the use of untreated histoplasmin in diagnostic ELISAs. The high specificities, sensitivities, and simplicity of our ELISA support further development of a deglycosylated HMIN ELISA for clinical use and for monitoring the humoral immune response during therapy in patients with chronic and disseminated histoplasmosis.

DIC and Granulomatous Vasculitis in a Dog with Disseminated Histoplasmosis

2011 ◽  
Vol 47 (3) ◽  
pp. e26-e30 ◽  
Author(s):  
Chen Gilor ◽  
Marcella D. Ridgway ◽  
Kuldeep Singh
Keyword(s):  
Supportive Care ◽  
Antifungal Therapy ◽  
Histoplasma Capsulatum ◽  
Giant Cells ◽  
Multinucleated Giant Cells ◽  
Disseminated Intravascular Coagulopathy ◽  
Granulomatous Vasculitis ◽  
Disseminated Histoplasmosis ◽  
Mixed Breed ◽  
Intravascular Coagulopathy

Disseminated histoplasmosis and disseminated intravascular coagulopathy were diagnosed in a 7 mo old, female spayed mixed-breed dog. The dog improved transiently with supportive care, but deteriorated shortly after initiation of antifungal therapy. The dog was subsequently euthanized. At necropsy, marked granulomatous vasculitis was identified in all affected organs. The tunicae and laminae of the arteries and arterioles were obscured by epithelioid macrophages and multinucleated giant cells admixed with necrotic material. Intracytoplasmic yeast were present within some of these macrophages. To the authors' knowledge, this is the first reported case of granulomatous vasculitis associated with Histoplasma capsulatum in a dog.

Potential benefit of combination antifungal therapy in Aspergillus endocarditis

2020 ◽  
Vol 13 (6) ◽  
pp. e234008 ◽  
Author(s):  
Kate Lennard ◽  
Aiveen Bannan ◽  
Peter Grant ◽  
Jeffrey Post
Keyword(s):  
Aortic Valve ◽  
Antifungal Therapy ◽  
Case Reports ◽  
Single Agent ◽  
Survival Rates ◽  
Rare Condition ◽  
Prosthetic Aortic Valve ◽  
Single Agent Therapy

Aspergillus endocarditis (AE) is a rare condition with a mortality rate greater than 60%. While it is generally accepted that both antifungal therapy and surgery are necessary for survival, the optimal antifungal regimen is unclear. A 62-year-old man was diagnosed with AE of a prosthetic aortic valve, complicated by cerebral emboli. He underwent debridement of the aortic valve abscess and valve replacement, and was managed with a combination of liposomal amphotericin B and voriconazole for 7 weeks followed by long-term suppressive azole therapy. He remained well at follow-up 18 months later. Data from a review of case reports published between 1950 and 2010 revealed greater survival rates in patients managed with two or more antifungals as opposed to single agent therapy. We provide an updated literature review with similar findings, suggesting that dual agent antifungal therapy should be considered in patients with AE.

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