Liposomal amphotericin B as rescue treatment to Itraconazole refractory disseminated histoplasmosis in an immunocompetent patient

Articles in Press

Document Type : Case report

Authors

1 Department of Microbiology, King George’s Medical University, Lucknow, India

2 Department of Pathology, King George’s Medical University, Lucknow, India

3 Department of Respiratory Medicine, King George’s Medical University, Lucknow, India

10.22034/cmm.2025.345354.1613

Abstract

Background and purpose: Histoplasmosis, caused by Histoplasma capsulatum, typically presents as a pulmonary infection but can disseminate, with oral lesions common in immunocompromised individuals. In immunocompetent patients, this is rare. Preferred treatments include itraconazole for mild cases and liposomal amphotericin B for severe forms.
Case presentation: We report a 28-year-old female who developed disseminated histoplasmosis following a right oroantral fistula after dental surgery. Initially misdiagnosed as Actinomycosis, a positive urinary histoplasma antigen test confirmed histoplasmosis. Despite itraconazole therapy (200 mg twice daily, later increased to 600 mg), her condition worsened, with disease progression seen on imaging. Switching to six weeks of intravenous liposomal amphotericin B led to marked improvement, resolution of lung nodules, and negative antigen testing. She was discharged on itraconazole for 12 months.
Conclusion: This case highlights the importance of timely recognition and adjustment of treatment in non-severe histoplasmosis, particularly for patients who do not respond adequately to itraconazole therapy.

Keywords

Main Subjects

Current Medical Mycology

Articles in Press, Accepted Manuscript
Available Online from 07 April 2025

Files

History

  • Receive Date: 15 January 2025
  • Revise Date: 25 March 2025
  • Accept Date: 07 April 2025
  • Publish Date: 07 April 2025

Share

How to cite

Statistics