title: Disseminated histoplasmosis presenting as diabetic keto-acidosis in an immunocompetent patient.
abstract: Histoplasma capsulatum causes a spectrum of manifestations from asymptomatic to fatal disseminated disease. Disseminated histoplasmosis is mostly seen in endemic areas among immunocompromised patients such as those with AIDS. Here, we present a patient living in a non-endemic area with previously undiagnosed diabetes mellitus, who presented with septic shock and diabetic ketoacidosis (DKA), and was ultimately diagnosed with disseminated histoplasmosis. The patient rapidly recovered on administration of intravenous liposomal amphotericin followed by oral itraconazole. Uncontrolled diabetes may be a risk factor for disseminated or severe histoplasmosis in otherwise immunocompetent patients.
authors.affiliation: Department of Infectious Diseases, North Shore University Hospital, Manhasset, New York, USA.
authors.forename: Negin
authors.initials: N
authors.lastname: Niknam
authors.affiliation: Department of Infectious Diseases, North Shore University Hospital, Manhasset, New York, USA.
authors.forename: Prashant
authors.initials: P
authors.lastname: Malhotra
authors.affiliation: North Shore University Hospital, Manhasset, New York, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Kim
authors.affiliation: Long Island Jewish Medical Center, New Hyde Park, New York, USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Koenig
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D057210:Delayed Diagnosis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis; D016883:Diabetic Ketoacidosis / Q000150:complications* / Q000175:diagnosis; D006658:Histoplasma; D006660:Histoplasmosis / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007121:Immunocompetence; D008297:Male; D014057:Tomography, X-Ray Computed; D014195:Travel; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B