title: Ileal perforation and reactive hemophagocytic syndrome in a patient with disseminated histoplasmosis: the role of the real-time polymerase chain reaction in the diagnosis and successful treatment with amphotericin B lipid complex.
abstract: The following case illustrates an ileal perforation and reactive hemophagocytic syndrome (RHS) resulting from disseminated histoplasmosis in a patient with Human Immunodeficiency Virus (HIV) from Puerto Rico. Although the diagnosis was established by histopathologic findings and a positive bone marrow culture, Histoplasma capsulatum-specific real-time Polymerase Chain Reaction (PCR) allowed to confirm the diagnosis from formalin-fixed, paraffin-embedded tissue. Interestingly, the Histoplasma antigens in both serum and urine samples were falsely negative. Amphotericin B lipid complex (Abelcet), followed by oral itraconazole, led to a successful response and resolution of symptoms. A short review of the clinical signs and symptoms, diagnostic tests, and therapeutic options for disseminated histoplasmosis is done, with emphasis on the role of Histoplasma-specific real-time PCR as a molecular diagnostic tool and the efficacy of treatment with one of the lipid formulations of amphotericin B.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Puerto Rico School of Medicine, San Juan, PR 00936, USA. humberto@guiot.com
authors.forename: Humberto M
authors.initials: HM
authors.lastname: Guiot
authors.forename: Jorge
authors.initials: J
authors.lastname: Bertrán-Pasarell
authors.forename: Lee Marie
authors.initials: LM
authors.lastname: Tormos
authors.forename: Carmen
authors.initials: C
authors.lastname: González-Keelan
authors.forename: Gary W
authors.initials: GW
authors.lastname: Procop
authors.forename: Jean
authors.initials: J
authors.lastname: Fradera
authors.forename: Carlos
authors.initials: C
authors.lastname: Sánchez-Sergentón
authors.forename: William
authors.initials: W
authors.lastname: Méndez
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004338:Drug Combinations; D015658:HIV Infections / Q000150:complications / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006658:Histoplasma / Q000235:genetics / Q000302:isolation & purification*; D006660:Histoplasmosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007082:Ileum / Q000473:pathology; D007416:Intestinal Perforation / Q000150:complications*; D051359:Lymphohistiocytosis, Hemophagocytic / Q000150:complications*; D008297:Male; D010713:Phosphatidylcholines / Q000008:administration & dosage / Q000627:therapeutic use*; D010715:Phosphatidylglycerols / Q000008:administration & dosage / Q000627:therapeutic use*; D011647:Puerto Rico; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D004338:Drug Combinations; D010713:Phosphatidylcholines; D010715:Phosphatidylglycerols; C068538:liposomal amphotericin B; D000666:Amphotericin B