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Disseminated histoplasmosis in an immunosuppressed patient successfully treated with isavuconazole
  1. Anita D Sircar1,
  2. Mai-Chi N Tran2,
  3. Sagar A Vaidya3,
  4. Ellie JC Goldstein4 and
  5. L Joseph Wheat5
  1. 1Infectious Diseases, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
  2. 2Pharmacy Department, MemorialCare Orange Coast Medical Center, Fountain Valley, California, USA
  3. 3Family Medicine, University of California, San Diego, CA, USA
  4. 4RM Alden Research Laboratory, Santa Monica, California, USA
  5. 5MiraVista Diagnostics, Indianapolis, Indiana, USA
  1. Correspondence to Dr Anita D Sircar; asircar{at}


Histoplasmosis is an endemic fungal infection caused by the dimorphic fungus, Histoplasma capsulatum, which is treated with intravenous amphotericin B and oral itraconazole as first-line and second-line therapy. We report a case of a man in his early 70s treated with methotrexate and infliximab for rheumatoid arthritis who developed disseminated histoplasmosis. The patient was unable to absorb itraconazole due to intractable diarrhoea and developed a severe, anaphylactoid reaction or an immune reconstitution inflammatory syndrome when treated with liposomal amphotericin B. He was subsequently treated with isavuconazole and steroids and made a full recovery.

A literature review revealed other cases of histoplasmosis which were treated with isavuconazole including both primary pulmonary and disseminated presentations. Cases of blastomycosis which were treated with isavuconazole are also reviewed including those with severe immunocompromised statuses including solid-organ transplant and tumour necrosis factor-alpha antagonist recipients. Our report describes the potential role of isavuconazole in cases of histoplasmosis where first-line and second-line therapies have failed or are contraindicated (excluding meningitis).

  • Infectious diseases
  • Immunology
  • Drugs: infectious diseases
  • Unwanted effects / adverse reactions
  • Rheumatoid arthritis

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  • Contributors The following author was responsible for drafting of the text, sourcing and editing of clinical images, investigating results, drawing original diagrams and algorithms, and critical revision for important intellectual content—AS, JW, EG, SV and M-CT. AS was also responsible for the case patient and was the senior clinician of the treating team. The following authors gave final approval of the manuscript—AS, JW, EG, SV and M-CT.

  • 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.