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Disseminated genitourinary histoplasmosis in a patient with AIDS with negative urine antigen testing
  1. Candice Theodora Joseph1,
  2. Michael Feely2 and
  3. Nicole Iovine1
  1. 1Infectious Disease and Global Medicine, University of Florida, Gainesville, Florida, USA
  2. 2Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, USA
  1. Correspondence to Dr Candice Theodora Joseph; c-joseph{at}live.com

Abstract

Disseminated histoplasmosis is a life-threatening condition in immunocompromised patients. The majority of healthy persons have benign disease not requiring treatment. However, in persons living with HIV, mortality is high and accurate diagnosis is paramount. We present a case of a 48-year-old HIV-positive woman who presented with haematuria and flank pain. She had a history of recurrent urinary tract infection and nephrolithiasis with obstructive hydronephrosis. During cystoscopy, a bladder lesion was found. Pathological evaluation demonstrated abundant intracellular organisms with apparent budding. Subsequent urine histoplasma antigen was negative. Given the high index of suspicion for histoplasmosis based on the surgical pathology findings and epidemiological history, the patient was started immediately on antifungal therapy. One week later, PCR results of the bladder lesion confirmed the presence of Histoplasma capsulatum. This case highlights a rare presentation of genitourinary histoplasmosis and the utility of surgical pathology evaluation and PCR for diagnosis.

  • HIV / AIDS
  • medical management
  • infections
  • haematuria

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Footnotes

  • Contributors CTJ designed and conceptualised the case reports and was involved in clinical care, data analysis and interpretation of results and drafting of initial manuscript. NI was involved in clinical care, data analysis and interpretation and revision of manuscript for intellectual content. MF was involved in interpretation of surgical pathology and revision of manuscript for intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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

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