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

You answered:

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.

This answer is incorrect. Fluconazole is second-line for treatment of histoplasmosis because it has higher rates of relapse than itraconazole.

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