title: Acute Disseminated Histoplasmosis with Atypical Lymphocytosis in an Immunocompetent Host.
abstract: 65 year-old-male presented with a one-week history of high grade fever, fatigue and confusion which began abruptly two days after a cystoscopy procedure. Past medical history included pulmonary sarcoidosis diagnosed by mediastinal lymph biopsy, diabetes and hypertension. On admission he was febrile and confused with stable vital signs. Initial workup included negative Head CT and lumbar puncture. Blood work revealed normal metabolic and liver function tests with progressive anemia, thrombocytopenia and atypical lymphocytosis of 15-20%. Blood, urine and respiratory cultures all were negative for bacteria and. A bone marrow biopsy was done given the abnormal lymphocytes in peripheral smear, revealing budding yeast consistent withHistoplasma capsulatum. Histoplasma antigen was positive in urine and eventually blood and bone marrow grewH. capsulatum. Patient was started on amphotericin-B for diagnosis of disseminated histoplasmosis. After a 2 week period of amphotericin B, patient was switched to oral Itraconazole to complete 12 months course of treatment.
authors.affiliation: Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA; Department of Cardiology, Ain Shams University, Cairo, Egypt.
authors.forename: Ayman
authors.initials: A
authors.lastname: Elbadawi
authors.affiliation: Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA.
authors.forename: Hamdy M A
authors.initials: HM
authors.lastname: Ahmed
authors.affiliation: Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA.
authors.forename: Hussain
authors.initials: H
authors.lastname: Adly
authors.affiliation: Department of Medicine, John H Stroger Hospital, Cook County, IL, USA.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elkhouly
authors.affiliation: Department of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Samar
authors.initials: S
authors.lastname: Abohamed
authors.affiliation: Department of Infectious Diseases, University of Rochester, Rochester, NY, USA.
authors.forename: Ann R
authors.initials: AR
authors.lastname: Falsey
keywords: Atypical lymphocytosis; Cystoscopy; Histoplasma; Histoplasmosis; Immunocompetence