Smith E, Franzman M, Mathiesen L; International Conference on AIDS.
Int Conf AIDS. 1989 Jun 4-9; 5: 235 (abstract no. M.B.P.79).
University of Copenhagen, Hvidovre Hospital, Copenhagen, Denwark
OBJECTIVE: To present the first case of disseminated histoplasmosis (DH) in an European AIDS pt. METHODS AND RESULTS: A 33-year old HIV-seropositive Danish homosexual with 2 weeks of fever, chills, a slight cough and a weight loss over the last 3 months. Examination showed a Kaposi's sarcoma in the mouth, oral thrush and a temperature of 38.4 degrees C. No lymph node swelling or organomegaly. White blood cell count was 2.700/mm3 and CD4 cell count was zero. X-ray of the chest showed diffuse bilateral infiltrates and from the bronchial lavage pneumococcer and candida were cultivated. Therapy was started with penicillin and ketoconazole 200 mg daily. A liver biopsy showed granulomata and a biopsy of the bone marrow was normal. A CAT-scan of the abdomen showed a slight hepatosplenomegaly and several lymph nodes in the retroperitoneum. Six weeks after admission he still had the fever and was losing weight. Zidovudine 1200 mg daily was started and an explorative laparotomy was done with the excision of a mesenterial lymph node. Histologic examination showed typical H. capsulatum in EM. A histoplasmin skin test and histoplasma serologic test of the urine and blood were all negative. He was treated with i.v. Amphotericin B 25 mg/day for 2 weeks to a total of 4.5 mg/kg. Then the treatment was changed to oral fluconazol 200 mg/day. The patient lived in Venezuela from 1983-1986 but otherwise in Europe. A CAT-scan 2 months later showed regression of the lymph nodes and no organomegaly. Eleven months after the diagnosis of DH he is feeling well on oral fluconazole 200 mg/day without any sign of relapse or other opportunistic infections. CD4 cell count is 250/mm3. CONCLUSION: DH should be suspected in HIV-positive patients also from non-endemic areas. A detailed travel history is essential. This patient got a much lower i.v. Amphotericin B dose than recommended but it seems to be sufficient when followed by oral fluconazole.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Amphotericin B
- Animals
- Biopsy
- CD4 Lymphocyte Count
- Candidiasis, Oral
- Cats
- Europe
- Fluconazole
- HIV Seropositivity
- Histoplasma
- Histoplasmin
- Histoplasmosis
- Homosexuality
- Humans
- Ketoconazole
- Opportunistic Infections
- Sarcoma, Kaposi
- Venezuela
- immunology
Other ID:
UI: 102176933
From Meeting Abstracts