DISSEMINATED HISTOPLASMOSIS IN AN ADOPTED INFANT FROM EL SALVADOR

An HIV-negative 4-month-old infant recently adopted from El Salvador w as admitted for high fever. Hepatosplenomegaly, anaemia, leucopenia, t hrombocytopenia, increased transaminases, and diffuse interstitial pul monary infiltration were present on admission. Granulomas were seen in bone marrow and liver biopsies without any organism. Disseminated his toplasmosis was diagnosed 2 weeks later when bone marrow and blood cul tures taken on admission became positive for Histoplasma capsulatum an d when histoplasmic antigen was detected in blood. The outcome was goo d after treatment with amphotericin B followed by itraconazole which w as administered for a 6-month period without significant toxicity. Con clusion Disseminated histoplasmosis is very rarely seen in Europe but should be suspected in case of unexplained fever in immigrants from th e endemic areas in the world, particularly when hepatosplenomegaly and pancytopenia are present. Bone marrow examination and culture, blood cultures, and antigen testing are the mainstays of the diagnosis.