title: Progressive disseminated histoplasmosis mimicking a flare of systemic lupus erythematosus: a European case report.
abstract: BACKGROUND
  Diagnosing progressive disseminated histoplasmosis (PDH) in patients with systemic lupus erythematosus (SLE) is diagnostically challenging. Since PDH is lethal when untreated, awareness of this infection in patients with SLE is of utmost importance. To the best of our knowledge, this is the first description of a case of PDH in a patient with SLE in Europe.
  
  
  METHODS
  A 56-year-old woman of Surinamese descent with a history of SLE, presented with fever and polyarthritis. Although a flare of SLE was suspected initially, cultures of bone marrow and broncho-alveolar lavage fluid grewHistoplasma capsulatum.
  
  
  CONCLUSIONS
  This case report highlights that physicians should be aware of progressive disseminated histoplasmosis in patients with SLE treated with immunosuppressive agents. The signs and symptoms can easily mimic a SLE flare, which would then be treated with more aggressive immunosuppression. Failure to recognize the infection will therefore invariably lead to death of the patient. Progressive disseminated histoplasmosis is usually not recognized by doctors in non-endemic areas such as Europe. However, globalisation and more frequent intercontinental traffic of immunocompromised patients currently increases the incidence of histoplasmosis in these areas. It is therefore of life-saving importance that doctors are aware of the features of the infection in areas whereH. capsulatumis not endemic.
authors.affiliation: Department of Medical Microbiology and Infection Control, VU University Medical Center , Amsterdam , the Netherlands.
authors.forename: M L M
authors.initials: ML
authors.lastname: van Doorn-Schepens
authors.affiliation: Department of Internal Medicine, VU University Medical Center , Amsterdam , the Netherlands.
authors.forename: E J
authors.initials: EJ
authors.lastname: Peters
authors.affiliation: Department of Rheumatology, VU University Medical Center , Amsterdam , the Netherlands.
authors.forename: R M
authors.initials: RM
authors.lastname: van Vugt
authors.affiliation: Intensive Care Unit, VU University Medical Center , Amsterdam , the Netherlands.
authors.forename: J I
authors.initials: JI
authors.lastname: van der Spoel
authors.affiliation: Department of Medical Microbiology and Infection Control, VU University Medical Center , Amsterdam , the Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: van Dijk
keywords: amphotericin B; disseminated; histoplasmosis