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Histoplasmosis in AIDS: unusual findings.
Altarac D; Salomon N; Saltzman BR; Efremov MH; Katchen BR; Dept. of
December 30, 1992
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