Meningitis due to Histoplasma capsulatum and Mycobacterium tuberculosis in a returned traveler with acquired immunodeficiency syndrome.
Histoplasmosis has rarely been reported in Taiwan, and its clinical manifestations may be similar to those of tuberculosis. With increasing international travel, physicians need to be aware of the possibility of this disease when caring for patients with advanced human immunodeficiency virus (HIV) infection who have traveled to endemic areas. A 55-year-old Chinese male from Burma presented with concurrent histoplasmosis and tuberculous meningitis as the initial opportunistic infection of acquired immunodeficiency syndrome. Fever, altered mentation, pancytopenia, splenomegaly and marked elevations of serum lactate dehydrogenase (3601 U/L) and ferritin (>10(6) ng/mL) were noted. Despite treatment with amphotericin B and antituberculous therapy, the patient died on the 25th day of hospitalization. This case illustrates the complexity and challenges of management of opportunistic infections in travelers returning from Southeast Asia who are in the advanced stage of HIV infection.
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Min-Nan
MN
Hung
Hsin-Yun
HY
Sun
Po-Ren
PR
Hsueh
Chien-Ching
CC
Hung
Shan-Chwen
SC
Chang
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000209:etiology*; D006660:Histoplasmosis / Q000150:complications*; D006801:Humans; D008297:Male; D016921:Meningitis, Fungal / Q000188:drug therapy / Q000209:etiology*; D008875:Middle Aged; D014195:Travel; D014390:Tuberculosis, Meningeal / Q000188:drug therapy / Q000209:etiology*