HIV-ASSOCIATED HISTOPLASMOSIS WITH PULMON ARY MANIFESTATIONS

A 35-year-old man developed weight loss, lower abdominal pain, diarrho ea, cough, fever and general deterioration in his health. He had been born and resident in the USA until 1991, when he moved to Germany. Sin ce 1991 he had known that he was HIV positive. The chest radiograph sh owed bilateral diffuse spotty marking and a rounded cardiac silhouette , the latter echo cardiographically due to pericardial effusion. Tuber culostatic drugs were started because miliary tuberculosis was suspect ed. But as his condition worsened and he was thought to have Pneumocys tis pneumonia high doses of co-trimoxa-zole were administered. Perbron chial lung biopsy showed nonspecific chronic inflammatory changes. Per iodide acid-Schiff reaction and Grocott staining demonstrated numerous histoplasma in alveolar macrophages and connective tissue. The organi sm was also cultured from bronchial secretions. Treatment was now chan ged to itraconazole (400mg daily), 2 weeks later changed to liposomal amphotericin B (100mg daily) because of renewed fever. After 6 weeks t he patient became free of symptoms and the radiological changes had la rgely regressed. To prevent recurrence, treatment with itraconazole (4 00mg daily) is being continued.