title: Pleural effusion due to Histoplasma capsulatum and idiopathic CD4 lymphocytopenia.
abstract: Acute histoplasmosis is usually a benign, self-limited infection in endemic areas. Since protection against Histoplasma capsulatum infection requires specific, cell-mediated immunity, histoplasmosis is well documented in patients with acquired T cell deficiencies e.g. due to HIV infection. We report here for the first time a case of pleural effusion due to H. capsulatum infection in a patient with idiopathic CD4 lymphocytopenia (ICL). A 25-year-old woman presented with chest pain, dyspnea on exertion and a moderate weight loss. Chest X-ray showed a large left pleural effusion, and thoracentesis yielded an exudate. Histologic examination of pleural biopsies identified H. capsulatum. Laboratory tests revealed lymphocytopenia with low CD4+ T cell counts (<100/microl) and a decreased CD4/CD8 ratio. Serology, including HIV, was repeatedly negative. The diagnosis of pleural effusion due to H. capsulatum infection in a patient with idiophatic ICL was established. There was no evidence of any other opportunistic infection. Treatment with itraconazole was initiated and pleural effusion resolved within 2 weeks of treatment. Moreover, the patient was found to have idiopathic thrombocytopenic purpura, as confirmed by the detection of autoantibodies against thrombocytes. In a 1-year follow-up, the patient remained asymptomatic without relapse or any new infection. Treatment with itraconazole was given for 12 months. Because of persistent CD4+ T cell counts below 100/microl, prophylactic antibiotic treatment is continued.
authors.affiliation: Department of Pneumology, St Hildegardis Hospital, Mainz, Germany. pneumo@kortsik.de
authors.forename: C
authors.initials: C
authors.lastname: Kortsik
authors.forename: A
authors.initials: A
authors.lastname: Elmer
authors.forename: I
authors.initials: I
authors.lastname: Tamm
mesh_terms: D000328:Adult; D005260:Female; D006658:Histoplasma / Q000302:isolation & purification*; D006660:Histoplasmosis / Q000150:complications*; D006801:Humans; D010996:Pleural Effusion / Q000209:etiology*; D018344:T-Lymphocytopenia, Idiopathic CD4-Positive / Q000150:complications*