A case report of disseminated histoplasmosis not responding to primary treatment by itraconazole

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 being common among immunocompromised individuals. However, this is rare among immunocompetent patients. Preferred treatments include itraconazole for mild cases and liposomal amphotericin B for severe forms.
Case presentation: This study aimed to report a 28-year-old female who developed disseminated histoplasmosis following a right oroantral fistula after dental surgery. It was initially misdiagnosed as Actinomycosis; however, a positive urinary histoplasma antigen test confirmed histoplasmosis. Despite itraconazole therapy (200 mg twice daily, later increased to 600 mg), her condition continued to deteriorate, 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 with a 12-month course of itraconazole therapy.
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.

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History

  • Receive Date: 15 January 2025
  • Revise Date: 25 March 2025
  • Accept Date: 06 April 2025
  • Publish Date: 24 May 2025

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