19 January 2020 : Case report
A Case of Pulmonary Histoplasmosis Presenting with Hypercalcemia and Altered Mental Status in a Patient Following Allogeneic Hematopoietic Stem Cell Transplantation
Rare coexistence of disease or pathologyJose A. Rodriguez1BEF*, Stipe Ivancic1BEF, Paula A. Eckardt2AD, Juan C. Lemos-Ramirez2DE, Jianli Niu3EG
Am J Case Rep 2020; 21:e919724
BACKGROUND: Histoplasmosis results from the inhalation of spores from the fungus, Histoplasma capsulatum. A case is presented of pulmonary histoplasmosis associated with altered mental state and hypercalcemia following allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia (AML).
CASE REPORT: A 75-year-old man with a five-day history of AML treated with allogeneic hematopoietic stem cell transplantation, presented with weakness, fatigue, and slow mentation. Computed tomography (CT) of the brain was unremarkable. Laboratory investigations showed serum albumin of 2.9 g/dL, calcium of 11.6 mg/dL, ionized calcium of 1.55 mmol/L, parathyroid hormone (PTH) <6.3 pg/mL, and 25-hydroxy vitamin D of 14.4 ng/mL. Treatment began with intravenous cefepime 1 gm bid, normal saline, and the bisphosphonate, pamidronate, administered as a single dose. Three days later, his clinical status declined. He developed a dry productive cough, his oxygen saturation (O₂ Sat) was 90%, and his mental status worsened. Chest CT showed diffuse bilateral lung infiltrates with ground glass opacities. Bronchioalveolar lavage and transbronchial biopsy were negative for Pneumocystis jiroveci pneumonia (PJP). The CMV rival load was 195 IU/mL. Urinalysis for Histoplasma antigen and the Fungitell® assay were positive. Treatment commenced with intravenous voriconazole (250 mg, bid) and ganciclovir (5 mg/kg, bid). A left lower lobe transbronchial lung biopsy was positive for Histoplasma capsulatum and negative for CMV.
CONCLUSIONS: This case report has highlighted the need for awareness of the diagnosis of histoplasmosis in patients with allogeneic hematopoietic stem cell transplantation who present with an altered mental state in the setting of hypercalcemia.
Keywords: Histoplasmosis, Hypercalcemia, Stem Cell Transplantation, Aged, Histoplasma, Immunocompromised Host, Leukemia, Myeloid, Acute, Lung Diseases, Fungal, Mental Disorders
28 Sep 2023 : Case reportSurgical Treatment of a Neglected Thumb Volar Plate Injury in an 11-Year-Old Girl: A Case Report
Am J Case Rep In Press; DOI: 10.12659/AJCR.940411
28 Sep 2023 : Case reportIleocolic Intussusception in Infancy is not Always Idiopathic – Adenomyoma as the Leading Point
Am J Case Rep In Press; DOI: 10.12659/AJCR.939789
27 Sep 2023 : Case reportLife-Threatening Cardiac Arrhythmias in a Case of Undetected Myxedema Coma: Importance of Early Detection a...
Am J Case Rep In Press; DOI: 10.12659/AJCR.941414
Most Viewed Current Articles
06 Dec 2021 : Case reportLipedema Can Be Treated Non-Surgically: A Report of 5 Cases
Am J Case Rep 2021; 22:e934406
07 Dec 2021 : Case reportEdwardsiella tarda: A Classic Presentation of a Rare Fatal Infection, with Possible New Background Risk Fac...
Am J Case Rep 2021; 22:e934347
13 Jul 2022 : Case reportWhistling Scrotum: An Unusual Presentation of Pneumomediastinum in the Setting of an Open Scrotal Wound
Am J Case Rep 2022; 23:e936441