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Progressive disseminated histoplasmosis presenting with cachexia and hypercalcemia

Authors Khasawneh F, Ahmed S, Halloush R

Received 12 December 2012

Accepted for publication 7 January 2013

Published 27 February 2013 Volume 2013:6 Pages 79—83


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Faisal A Khasawneh,1 Subhan Ahmed,2 Ruba A Halloush3

1Section of Infectious Diseases, Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, 2Section of Nephrology, Department of Internal Medicine, University of Oklahoma, Tulsa, OK, 3Amarillo Pathology Group, Amarillo, TX, USA

Abstract: Histoplasmosis is a common endemic mycosis. The majority of infections involving this dimorphic fungus are asymptomatic. Manifestations in symptomatic patients are diverse, ranging from flu-like illness to a more serious disseminated disease. We present here a case of chronic disseminated histoplasmosis mimicking a metastatic cancer. We reviewed the literature for cases of disseminated histoplasmosis presenting with hypercalcemia, focusing particularly on clinical presentation, risk factors predisposing for fungal infection, and outcome. We report a case of a 65-year-old diabetic male who presented with unexplained weight loss and hypercalcemia. Multiple brain space-occupying lesions and bilateral adrenal enlargement were evident on imaging studies. Biopsies showed caseating granulomas with budding yeast, consistent with histoplasmosis. The patient's symptoms resolved after liposomal amphotericin B and itraconazole therapy. Granulomatous diseases, including fungal infections, should be considered alongside malignancies, in patients with similar presentation.

Keywords: disseminated histoplasmosis, hypercalcemia

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