BONE AND JOINT INVOLVEMENT IN AFRICAN HISTOPLASMOSIS (HISTOPLASMA-DUBOISII) - REPORT OF A CASE AND REVIEW OF THE LITERATURE

The authors report a case of disseminated African histoplasmosis with bone and joint involvement in a black 28-year-old citizen of the Centr al African Republic who presented with a 17-month history of multiple osteoarticular lesions (sternoclavicular joints, humerus, ribs), cutan eous lesions (face, scalp, thorax), and lymphadenopathy. Clinical mani festations resolved rapidly under treatment with ketoconazole (600 mg/ d for 10 days then 400 mg/day for nine months). Persistent yeast cells were then found upon examination of a lymph node biopsy specimen. The characteristics and diagnosis of osteoarticular lesions due to Africa n histoplasmosis are discussed on the basis of a review of the literat ure. Bone and joint lesions due to African histoplasmosis have not yet been reported in patients with the acquired immunodeficiency syndrome . However, the expanding epidemic of human immunodeficiency virus infe ction in Africa can be expected to result in an increase in the incide nce of African histoplasmosis. Imidazole derivatives are easier to use on a long-term basis than amphotericin B and have significantly impro ved our ability to treat African histoplasmosis.