HISTOPLASMOSIS AND KIDNEY-DISEASE IN PATIENTS WITH AIDS

Renal disease in patients infected with human immunodeficiency virus ( HIV) often presents with significant proteinuria and progressive renal failure; focal glomerulosclerosis is the most common renal pathology identified, To our knowledge, we report the first case of nephrotic-ra nge proteinuria and preserved renal function in an HIV-infected patien t in association with disseminated histoplasmosis, The initial level o f proteinuria was 12.5 g/24 h. The patient developed a concomitant les ion on his neck, which was biopsied and identified as Histoplasma caps ulatum by fungal stains and culture. The serum CF titer of antibody ag ainst yeast antigens of H. capsulatum was 1:8. The level of serum albu min decreased to 2.0 g/dL, and the level of serum cholesterol increase d to 284 mg/dL. Immunohistochemical staining of renal biopsy tissue de monstrated immune complexes within the mesangium; H. capsulatum antige n was also demonstrated in the mesangium. Therapy with oral itraconazo le resulted in marked clinical improvement. The findings in this case emphasize the need to rule out treatable causes of the nephrotic syndr ome in AIDS, especially in cases of immune-complex glomerulonephritis.