A case of HIV-associated cerebral histoplasmosis successfully treated withfluconazole

Clinically apparent involvement of the central nervous system is a rare eve nt in cases of disseminated histoplasmosis. even in HIV-infected persons. D espite therapy with amphotericin B, mortality remains very high. Reported h ere is the case of an HIV-infected patient with a 3-month history of fever, cough, weight loss and miliary lung infiltrates. Four weeks after initiati on of tuberculostatic therapy, high-grade fever, neurological symptoms, per sonality changes and respiratory deterioration occurred. Magnetic resonance imaging of the brain showed multiple mass lesions, and a chest radiograph revealed worsening of pulmonary infiltrates. Methenamine silver staining of a lung biopsy specimen demonstrated Histoplasma capsulatum. Subsequently, this pathogen was cultured from lavage fluid. Following high-dose intraveno us fluconazole therapy (800 mg once daily), the patient's condition improve d markedly within 10 days, followed by an almost complete resolution of pul monary and cerebral mass lesions. This is believed to be the first document ed case of rapid improvement of disseminated histoplasmosis with central ne rvous system involvement in an HIV-infected patient upon induction of thera py with fluconazole.