title: Disseminated histoplasmosis in a non-immunocompromised child.
abstract: We describe a 2 year-old non-immunocompromised girl with disseminated histoplasmosis who presented with a 2-month history of fever and bloody diarrhoea. On presentation, she was severely wasted and anaemic. There were gross hepatosplenomegaly and multiple lymphadenopathy. A septic screen was negative. A subsequent stool culture isolated Salmonella enteriditis. Serial Widal-Weil Felix (WWF) titres showed serological response after 2 weeks of Ceftriaxone. However, she continued to have spiking fever, bloody diarrhoea and weight loss. She developed pancytopaenia and disseminated intravascular coagulation. A bone marrow aspirate and trephine, and lymph node biopsy showed the presence of Histoplasma capsulatum, confirmed by Gomori-Methenamine Silver staining. She responded to intravenous amphotericin B followed by fluconazole (intravenous then oral) for 6 months after discharge. Human Immunodeficiency Virus screening tests were negative. Complement and immunoglobulin levels were normal. T and B enumeration tests showed gross leucopaenia with very low T cell function with defective phagocytic function. A repeat T and B cell enumeration test and phagocytic function tests done 3 months later were normal.
authors.affiliation: Institute of Paediatrics, Hospital Kuala Lumpur, Jalan Pahang.
authors.forename: M
authors.initials: M
authors.lastname: Hasliza
authors.forename: N A
authors.initials: NA
authors.lastname: Nur Atiqah
authors.forename: C B
authors.initials: CB
authors.lastname: Lim
authors.forename: I H
authors.initials: IH
authors.lastname: Hussain
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001853:Bone Marrow / Q000382:microbiology; D002675:Child, Preschool; D004211:Disseminated Intravascular Coagulation / Q000382:microbiology; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006658:Histoplasma / Q000302:isolation & purification; D006660:Histoplasmosis / Q000150:complications / Q000188:drug therapy / Q000276:immunology* / Q000382:microbiology; D006801:Humans; D007107:Immune System / Q000503:physiopathology*; D010198:Pancytopenia / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole