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Learning from errors
CASE REPORT
Hiding in plain sight: a case of chronic disseminated histoplasmosis with central nervous system involvement
  1. Guramrinder Singh Thind,
  2. Sandeep Patri
  1. Internal Medicine, Western Michigan University School of Medicine, Kalamazoo, Michigan, USA
  1. Correspondence to Dr Guramrinder Singh Thind, guramrinder.thind{at}med.wmich.edu

Summary

A 64-year-old man presented with gradual onset of confusion, ataxia and 25-pound weight loss over 3 months. MRI of the brain revealed two enhancing cerebellar lesions suspicious for metastases. Positron emission tomography-CT showed enhancement of cervical and axillary lymph nodes. Left axillary lymph node biopsy showed no evidence of malignancy but instead showed fungal organisms morphologically consistent with Histoplasma spp. Disseminated histoplasmosis with central nervous system involvement was suspected. Further history revealed that the patient had been having subjective fever for the past several months. He has had mild pancytopenia for about 2 years, which had not been further evaluated. Additionally, he had an oesophagogastroduodenoscopy 3 months prior to admission, which had shown granulomatous gastritis. Subsequently, the diagnosis of disseminated histoplasmosis was confirmed by serological testing and bone marrow biopsy. The patient was started on liposomal amphotericin B. Unfortunately, the patient had a catastrophic stroke and was transitioned to comfort care measures.

  • Infectious Diseases
  • Infection (neurology)
  • Brain Stem / Cerebellum

https://doi.org/10.1136/bcr-2017-220476

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    Footnotes

    • Contributors Both authors contributed to the manuscript as follows: SP was part of the primary team that admitted the patient and GST was on the Infectious Disease team, which was consulted for the patient at that time. Hence, both authors were directly involved with patient care. GST did the literature review and manuscript write-up. SP revised the manuscript critically for important intellectual content. Both authors gave their final approval of the version to be published.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.