A Rare Case Report-Idiopathic CD4 Lymphocytopenia Leading to Disseminated Histoplasmosis

Abstract

Histoplasmosis, a granulomatous mycosis caused by the intracellular dimorphic fungus Histoplasma capsulatum, has not been reported in Indian literature. The clinical spectrum of histoplasmosis varies from asymptomatic infections to disseminated histoplasmosis (PDH), depending on the intensity of the injury and the immunity of the exposed person. Infections most often occur in immunocompromised individuals, especially those with compromised immune systems such as HIV with low CD4+ lymphocytes, malignancies, or those who have received other immunosuppressive therapies. Keeping a high clinical suspicion regarding a differential diagnosis of histoplasmosis is required to prevent misdiagnosis, particularly in high-risk patients and initiate early antifungal therapy, which ameliorates the patient’s prognosis. Here, we present a case report of a middle-aged diabetic man who presented in our institute as a referral case from a private hospital with complaints of anorexia, fatigue, low-grade fever and decreased urination for 2 months with subsequent weight loss. His bone marrow biopsy confirmed infiltration with H. capsulatum. Subsequent 6 week apart CD4 counts were less than 300/mm3 without HIV-positive status or other acquired immunodeficiency, consistent with idiopathic cd4 lymphocytopenia. After a varied clinical course of intensive care stay, the patient was well treated with antifungal medications, showed remarkable improvement and was subsequently discharged in good condition.