DISSEMINATED HISTOPLASMOSIS IN AIDS

A 41-year-old man infected with HIV-1 developed fever up to 39.8 degre es C together with nonproductive cough and dyspnoea. Lactate dehydroge nase concentration rose from a level of 998 U/l to 6307 U/l. As Pneumo cystis carinii pneumonia was at first suspected he was treated with co -trimoxazole (1600 mg sulfamethoxazole and 320 mg trimethoprim, four t imes daily). But the symptoms did not abate. Bone-marrow puncture reve aled numerous macrophages containing ovoid inclusions typical of Histo plasma capsulatum varietas capsulatum. The diagnosis of disseminated h istoplasmosis was confirmed by culture and serologically by an increas e in Histoplasma polysaccharide antigen. On treatment with amphoterici n B (at first 10 mg, then 50 mg daily for 4 weeks) the symptoms regres sed within a few days. After the concentrations of lactate dehydrogena se and Histoplasma antigen had become normal again, maintenance treatm ent was changed to itraconazole (200 mg twice daily), after a total am photericin B dose of 1150 mg. The patient has remained free of recurre nce.