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

Question | Discussion | References | CME Credit

You answered:

	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.

	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.
	For patients taking itraconazole maintenance therapy, serum itraconazole levels should be monitored, at least initially.
	During maintenance therapy, obtaining Histoplasma antigen levels is not recommended because they have no value in monitoring for relapse.

[Back to Case 8 Question | Go to Correct Answer]