Disseminated histoplasmosis in corticosteroid-treated patients. Report of five cases
W. E. Dismukes, S. A. Royal and B. S. Tynes
Although Histoplasma capsulatum is not generally considered an
opportunistic organism, we have seen five corticosteroid-treated patients
in whom disseminated histoplasmosis (DH) developed. Persistent, unexplained
fever was the predominant symptom in each. Death was directly attributable
to DH in four. The interval from onset of symptoms to diagnosis ranged from
11 to 75 days; delay in diagnosis adversely affected prognosis. Culture of
the bone marrow appears to be the best diagnostic study. The pathologic
features of DH in immunocompromised hosts are the presence of large numbers
of Histoplasma yeast forms within macrophages, absence of discrete
granulomas, and a reduced or absent inflammatory response. Histoplasma
capsulatum should be considered as a possible cause in any immunosuppressed
patient with unexplained fever, especially if the patient has been
receiving corticosteroid therapy.
