Question | Discussion | References | CME Credit

Case 8: A 27-Year-Old Man with AIDS and Disseminated Histoplasmosis

You answered:

A The preferred initial therapy for HIV-infected patients with progressive severe disseminated histoplasmosis is itraconazole (Sporanox).

This answer is incorrect. The preferred initial therapy for progressive moderate to severe disseminated histoplasmosis is liposomal amphotericin B (AmBisome) for 1-2 weeks, followed by itraconazole for at least 12 months of maintenance therapy. Alternatives to liposomal amphotericin B for initial therapy include amphotericin B lipid complex (Abelcet) and deoxycholate amphotericin B.

B If the patient does not tolerate itraconazole for maintenance therapy, fluconazole (Diflucan) can be used and expected to have the same rate of fungal suppression and relapse.
C For patients taking itraconazole maintenance therapy, serum itraconazole levels should be monitored, at least initially.
D During maintenance therapy, obtaining Histoplasma antigen levels is not recommended because they have no value in monitoring for relapse.

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