title: Histoplasma capsulatum reactivation with haemophagocytic syndrome in a patient with chronic lymphocytic leukaemia.
abstract: We describe a case of haemophagocytic syndrome caused by Histoplasma capsulatum reactivation in a patient with chronic lymphocytic leukaemia treated with fludarabine and alemtuzumab. He presented with fever, pancytopenia, increased serum ferritin, lactate dehydrogenase and soluble interleukin-2 receptor. A bone marrow aspirate showed haemophagocytosis and possibly a yeast infection. Treatment with cyclosporine, dexamethasone, etoposide and caspofungin was started. After initial improvement his condition deteriorated. A second bone marrow examination confirmed a Histoplasma infection. After treatment with amphotericin B, the fever resolved and blood counts normalised. Haemophagocytic syndrome is a critical condition with high mortality that requires immunosuppressive therapy. The underlying cause should be investigated and treated. In this case a Histoplasma reactivation is described in a severely immunocompromised host years after the patient had left the endemic area.
authors.affiliation: Department of Internal Medicine, Reinier de Graaf Hospital, Delft, the Netherlands.
authors.forename: M P
authors.initials: MP
authors.lastname: van Koeveringe
authors.forename: R E
authors.initials: RE
authors.lastname: Brouwer
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D006660:Histoplasmosis / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D016867:Immunocompromised Host; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000276:immunology*; D051359:Lymphohistiocytosis, Hemophagocytic / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents