Presentation and Treatment of Histoplasmosis in Pediatric Oncology Patients: Case Series and Review of the Literature.
Histoplasmosis is an endemic fungus in several regions of the United States. The diagnosis and treatment of this infection can be challenging in pediatric oncology patients. We present 5 patients diagnosed with histoplasmosis while receiving treatment at a midsize pediatric oncology center in Iowa. Two cases occurred in patients with acute lymphoblastic leukemia and 3 cases in patients with solid tumors. All patients were treated with antifungal therapy and demonstrated excellent clinical response. Histoplasmosis should be considered as a potential cause of nonspecific febrile illness, pulmonary masses, and bone marrow suppression in immunocompromised patients in endemic regions. Prompt and accurate diagnosis can facilitate timely antifungal therapy and avoidance of prolonged hospital stays, invasive testing, unnecessary antibiotics, and unwarranted anticancer therapies.
*Blank Children's Hospital Pediatric Residency Program †Blank Children's Cancer and Blood Disorders Center ‡Iowa Pathology Associates, Des Moines, IA.
Jennifer
J
Hess
Andrew
A
Fondell
Nicholas
N
Fustino
Jeff
J
Malik
Christopher
C
Rokes
D000008:Abdominal Neoplasms / Q000150:complications*; D000293:Adolescent; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001853:Bone Marrow / Q000000981:diagnostic imaging; D002051:Burkitt Lymphoma / Q000150:complications* / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D058405:Desmoplastic Small Round Cell Tumor / Q000150:complications*; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D019353:Endemic Diseases; D064147:Febrile Neutropenia / Q000209:etiology; D006660:Histoplasmosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D007484:Iowa / Q000453:epidemiology; D017964:Itraconazole / Q000627:therapeutic use; D008168:Lung / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000556:secondary; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy; D012509:Sarcoma / Q000150:complications* / Q000556:secondary / Q000628:therapy
D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B