title: Progressive disseminated histoplasmosis in an immunocompetent patient as an underrecognized imported mycosis in Japan.
abstract: Histoplasmosis caused by Histoplasma capsulatum is found worldwide. Japan is known to be non-endemic area. Progressive disseminated histoplasmosis (PDH) is a severe form of histoplasmosis. We report a case of PDH in a 54-year-old male who was not immunocompromised. His last travel history to an endemic region was 2 years before onset. He was diagnosed as histoplasmosis by 18S rRNA-PCR from serum and ascites and immunodiffusion test. We treated him with parental liposomal amphotericin B for 2 weeks then changed to oral itraconazole, which was continued for 6 months. Rigorous work up, including HIV status, lymphocyte counts, and adrenal function did not reveal any evidence of immunosuppression of the patient. Our case suggests that PDH can occur in immunocompetent patients as previously described, and must be included in the differential diagnoses if presentation is consistent. In addition, the skills of travel history taking are emphasized.
authors.affiliation: Division of Infectious Disease Therapeutics, Department of Microbiology and Infectious Diseases, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan. ohji@med.kobe-u.ac.jp
authors.forename: Goh
authors.initials: G
authors.lastname: Ohji
authors.forename: Ken
authors.initials: K
authors.lastname: Kikuchi
authors.forename: Keiichi
authors.initials: K
authors.lastname: Inoue
authors.forename: Kazuya
authors.initials: K
authors.lastname: Imoto
authors.forename: Shungo
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Naoto
authors.initials: N
authors.lastname: Hosokawa
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Kamei
authors.forename: Kentaro
authors.initials: K
authors.lastname: Iwata
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D006658:Histoplasma / Q000235:genetics / Q000302:isolation & purification*; D006660:Histoplasmosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007121:Immunocompetence; D017964:Itraconazole / Q000627:therapeutic use; D007564:Japan; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods; D012337:RNA, Ribosomal, 18S / Q000235:genetics; D014195:Travel
chemical_list: D000935:Antifungal Agents; D012337:RNA, Ribosomal, 18S; C068538:liposomal amphotericin B; D017964:Itraconazole; D000666:Amphotericin B