Question | Discussion | References | CME Credit

Updated April 3, 2008

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

Authors: Brian R. Wood, MD David H. Spach, MD

A 27-year-old man from Mexico with newly diagnosed HIV (CD4 count 7 cells/mm3 and HIV RNA greater than 1 million copies/ml) presents to the clinic with 4 weeks of fever, chills, night sweats, myalgias, dry cough, nausea, vomiting, and diarrhea. He has watery bowel movements 1-2 hours after eating, and has lost 25 lbs in the last 4 weeks. He recently had a negative tuberculin skin test. Initial evaluation shows hypoxia evident on an arterial blood gas and a chest radiograph with diffuse hazy opacities (Figure 1). He is initially treated for presumptive Pneumocystis pneumonia and atypical pneumonia. Two weeks later, however, fungal blood cultures show growth of hyphal elements identified as Histoplasma capsulatum and thus he is diagnosed with progressive disseminated histoplasmosis.

Which of the following is True about this patient’s treatment?

A The preferred initial therapy for HIV-infected patients with progressive severe disseminated histoplasmosis is itraconazole (Sporanox).
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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    Figure 1 - Chest Radiograph of AIDS Patient with Disseminated Histoplasmosis Figure 1