Disseminated and central nervous system Histoplasma capsulatum infection mimicking neoplasm: difficulties in diagnosis, failure in management

• Published in: La revue de medecine interne 2003-06, Vol.24 (6), p.389-393
• Main Authors: Nicolas, X, Granier, H, Laborde, J-P, Talarmin, F, Zagnoli, F, Garin, A, Le Flohic, A-M, Moalic, E, Quinio, D, Klotz, F
• Format: Article
• Language: eng ; fre
• Subjects: Brain Neoplasms - diagnosis; Central Nervous System Diseases - diagnosis; Central Nervous System Diseases - microbiology; Diagnosis, Differential; Fatal Outcome; France; Histoplasmosis - diagnosis; Humans; Magnetic Resonance Imaging; Male; Middle Aged
• ISSN: 0248-8663
• DOI: 10.1016/S0248-8663(03)00073-0

Infection with Histoplasma capsulatum (Hc) is a rare importing disease in metropolitan France, the most often minor but sometimes letal in its spread form. A 58 years old French man, HIV seronegative, was admitted for an alteration of its general condition, disorder and buccal ulcerations. He had a prostate cancer history and came back in France after 17 years in Central Africa. The imaging showed numerous cerebral nodes, a bilateral adrenal tumor, and pulmonary calcifications. Histoplasmosis diagnosis has been done after neurosurgical cerebral biopsy which displayed characteristic Hc. The sick man died 4 months later with multivisceral failures, in spite of amphotericine B treatment followed by oral then intraveinous itraconazole. Even in an old tropical residence, ones can be able to conjure up a deep exotic fungal infection, and most specifically Hc histoplasmosis, in front of meaningful multivisceral lesions. Disseminated histoplasmosis (HD) with neurological location is misleading, mimicking tuberculosis or cancer. In order to obtain formal mycological evidence, ones have to make adapted biopsies. Antifungal agents must take into account medicinal interaction. Therefore, prognosis is bad, according to inoculum, immunodeficiency, age of disease and diagnosis delay.