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Histoplasmosis in AIDS: unusual findings.


Int Conf AIDS. 1992 Jul 19-24;8(3):50 (abstract no. PuB 7006). Unique

OBJECTIVE: To describe uncommon manifestations of histoplasmosis in AIDS. METHODS: 1) Identification of cases through a) computer search of discharge diagnosis of histoplasmosis and b) review of infectious diseases consult service and pathology records for the period 1988-91. 2) Retrospective chart review. RESULTS: We identified 9 cases of histoplasmosis with HIV infection. Mean age was 43 years. Sex: 8(89%) males, 1(11%) females. Race/ethnicity: 8(89%) hispanic, 1 (11%) black. HIV risk factors: 4(44%) intravenous drug use, 4(44%) heterosexual contacts, 1(11%) bisexual male. Place of former residence: 7(78%) Puerto Rico, 1 (11%) Ecuador, 1(11%) Tennessee, USA. Clinical presentations of histoplasmosis: 3 (33%) small bowel obstruction (including 1 with pneumonia), 3(33%) FUO, 2(22%) mucocutaneous (1 with condyloma-like perianal nodules, 1 with violaceous nodules on the forehead and intranasal mass), 1(11%) colitis. Histoplasmosis was the AIDS-defining infection in 7(78%); T4 cell counts were available for 6(86%) of the 7 patients [median T4 cell count = 25/mm3 (range 2-53)]. The diagnosis was confirmed in 8(89%) by: 2(25%) exploratory laparotomy and small bowel resection, 2(25%) skin biopsy, 2(25%) bone marrow biopsy, 1(12%) transbronchial biopsy, 1(12%) colonoscopy and biopsy. The remaining patient was diagnosed with histoplasmosis at necropsy; sites of involvement were lungs, liver, spleen, kidneys, lymph nodes, and bone marrow. Six (75%) were treated with amphotericin b; 5 improved and 1 expired. Two (25%) were treated with ketoconazole; 1 improved and 1 had progressive disease but subsequently improved on fluconazole. CONCLUSIONS: 1) All the patients with histoplasmosis seen in our institution had lived in an endemic area. 2) The majority had evidence of severe immune compromise. 3) Small bowel obstruction and condyloma-like lesions were among the unusual findings.

Acquired Immunodeficiency Syndrome/*COMPLICATIONS/IMMUNOLOGY Adult Female Histoplasmosis/*COMPLICATIONS/DIAGNOSIS Human Male ABSTRACT


Information in this article was accurate in December 30, 1992. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.