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Ramírez JA, Reyes-Montes MDR, Rodríguez-Arellanes G, Pérez-Torres A, Taylor ML. Central Nervous System Histoplasmosis: An Updated Insight. Pathogens 2023; 12:pathogens12050681. [PMID: 37242351 DOI: 10.3390/pathogens12050681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 05/28/2023] Open
Abstract
Histoplasmosis is one of the systemic mycoses that can involve the Central Nervous System (CNS), and it is caused by the dimorphic ascomycete species of the Histoplasma capsulatum complex. Once in the CNS, this pathogen causes life-threatening injuries that are associated with clinical manifestations of meningitis, focal lesions (abscesses, histoplasmomas), and spinal cord injuries. The present review provides updated data and highlights a particular vision regarding this mycosis and its causative agent, as well as its epidemiology, clinical forms, pathogenesis, diagnosis, and therapy, focusing on the CNS.
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Affiliation(s)
- José Antonio Ramírez
- Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, Mexico City 04510, Mexico
| | - María Del Rocío Reyes-Montes
- Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, Mexico City 04510, Mexico
| | - Gabriela Rodríguez-Arellanes
- Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, Mexico City 04510, Mexico
| | - Armando Pérez-Torres
- Departamento de Biología Celular y Tisular, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, Mexico City 04510, Mexico
| | - Maria Lucia Taylor
- Unidad de Micología, Departamento de Microbiología-Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), CDMX, Mexico City 04510, Mexico
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Development of an Interferon-Gamma Release Assay (IGRA) to Aid Diagnosis of Histoplasmosis. J Clin Microbiol 2022; 60:e0112822. [PMID: 36190260 PMCID: PMC9580355 DOI: 10.1128/jcm.01128-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Establishing diagnosis of latent and active histoplasmosis is challenging. Interferon gamma-release assays (IGRAs) may provide evidence of latent and active infection. An enzyme-linked immunospot (ELISpot) assay was developed using yeast cell lysate (YCL) antigen prepared from a representative North American Histoplasma capsulatum strain. Assay parameters were optimized by measuring responses in healthy volunteers with and without Histoplasma infection. Assay performance as an aid for diagnosing histoplasmosis was assessed in a prospective cohort of 88 people with suspected or confirmed infection, and 44 healthy controls enrolled in two centers in North America (2013 to 2018). Antigen specificity of IFN-γ release was demonstrated using ELISpot and enzyme-linked immunosorbent assay (ELISA). Antigen-evoked, single-cell mRNA expression by memory T cells was shown using flow cytometry. The area under the receiver operating characteristic curve (AUC) was estimated at 0.89 (95% confidence interval [CI]: 78.5% to 99.9%). At optimal cutoff, sensitivity was 77.2% (95% CI: 54.6% to 92.2%) and specificity was 100% (95% CI: 89.7% to 100%). Sixteen of 44 healthy volunteers (36.4%) from a region of hyperendemicity had positive responses, suggesting detection of previously unrecognized (latent) infection. The ELISpot assay is sensitive and specific as an aid to diagnose H. capsulatum infection and disease, supporting proof of concept and further development.
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3
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Khalaf SA, Patel P, Caruso CR, Parrett T, Bran A. CNS Histoplasmosis as a Gliosarcoma mimicker: The diagnostic dilemma of solitary brain lesions. IDCases 2022; 27:e01364. [PMID: 35024338 PMCID: PMC8724962 DOI: 10.1016/j.idcr.2021.e01364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022] Open
Abstract
Histoplasmosis is usually a benign, self-limited disease with lungs predilection. However, it might manifest as a disseminated disease in immunocompromised individuals. The involvement of the central nervous system (CNS) accounts for about 5–10% of cases with disseminated disease. Isolated histoplasmosis of the CNS is rare, and the literature shows only a few reported cases. By imaging studies, it usually presents as an isolated ring-enhancing lesion. Its spectrum of symptoms ranges from acute severe infection to progressive chronic meningitis, which delays the initial diagnosis, correct work-up and initiation of appropriate therapy. We present a case of a 57-year-old man from the Midwest of the United States who misdiagnosed with Gliosarcoma in 2019, for which he underwent appropriate management for Gliosarcoma. Presented for follow-up after new neurological symptoms; worsening in ring-enhancing brain lesions was found on magnetic resonance image MRI. After a re-examination of surgical pathological cases, histoplasmosis of the CNS was diagnosed. Failure of diagnosis CNS histoplasmosis early can lead to poor outcome and decrease chances of recovery.
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Affiliation(s)
- Suha Abu Khalaf
- University of Missouri, Division of Infectious Diseases, Columbia, MO, USA
| | - Paragkumar Patel
- University of Missouri, Division of Infectious Diseases, Columbia, MO, USA
| | - Carla R Caruso
- University of Missouri, Department of Pathology and Anatomical Sciences, Columbia, MO, USA
| | - Timothy Parrett
- University of Missouri, Department of Pathology and Anatomical Sciences, Columbia, MO, USA
| | - Andres Bran
- University of Missouri, Division of Infectious Diseases, Columbia, MO, USA
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4
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de Almeida SM, Imano ECM, Vicente VA, Gomes RR, Trentin AP, Zamarchi K, Schneider GX, Pinheiro RL, da Silva NM, de Hoog GS. Primary Central Nervous System Infection by Histoplasma in an Immunocompetent Adult. Mycopathologia 2020; 185:331-338. [PMID: 31989393 DOI: 10.1007/s11046-019-00394-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/28/2019] [Indexed: 12/17/2022]
Abstract
Central nervous system (CNS) infection by Histoplasma capsulatum is a rare disease in immunocompromised individuals in endemic areas. About one quarter of cases result from hematogenous dissemination. A 23-year-old upholsterer with chronic occipital headache had developed intracranial hypertension and dizziness, incoordination with ataxic gait, and acute confusion 5 months prior to admission. Laboratory examinations and chest roentgenogram were normal. Postcontrast T1-weighted MRI of the brain revealed a multiple ring-enhancing cerebellar, brain stem and parietal lobe lesions, and meningeal contrast enhancement. Cerebrospinal fluid culture was positive for H. capsulatum species complex, which was confirmed by phylogenetic analysis. Thirteen years after the diagnosis and treatment, there was no H. capsulatum recurrence; sequels related to complications due to the ventriculoperitoneal shunt. This case shows a primary neurological presentation of cerebral histoplasmosis, without meningitis or disseminated disease in nonimmune-compromised patient. The authors propose a categorization of the diagnosis of CNS histoplasmosis. Routine diagnostics of sibling species within the H. capsulatum complex proved to be difficult.
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Affiliation(s)
- Sérgio M de Almeida
- Diagnostic Support Unit, Hospital of Clinics, Federal University of Parana, Curitiba, Parana, Brazil
| | - Elaine C M Imano
- Microbiology, Parasitology and Pathology Postgraduate Program, Pathology Basic Department, Federal University of Parana, Curitiba, Parana, Brazil
| | - Vania A Vicente
- Microbiology, Parasitology and Pathology Postgraduate Program, Pathology Basic Department, Federal University of Parana, Curitiba, Parana, Brazil.
| | - Renata R Gomes
- Microbiology, Parasitology and Pathology Postgraduate Program, Pathology Basic Department, Federal University of Parana, Curitiba, Parana, Brazil
| | - Ana P Trentin
- Diagnostic Support Unit, Hospital of Clinics, Federal University of Parana, Curitiba, Parana, Brazil.,Neuroinfection Clinic, Hospital of Clinics, Federal University of Parana, Curitiba, Parana, Brazil
| | - Kassiely Zamarchi
- Microbiology, Parasitology and Pathology Postgraduate Program, Pathology Basic Department, Federal University of Parana, Curitiba, Parana, Brazil
| | - Gabriela X Schneider
- Microbiology, Parasitology and Pathology Postgraduate Program, Pathology Basic Department, Federal University of Parana, Curitiba, Parana, Brazil
| | - Rosangela L Pinheiro
- Department of Mycology, Hospital of Clinics, Federal University of Parana, Curitiba, Parana, Brazil
| | - Nickolas M da Silva
- Bioprocess Engineering and Biotechnology Department, Federal University of Parana, Curitiba, Parana, Brazil
| | - G S de Hoog
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands.,Center of Expertise in Mycology, Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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Fakhfakh N, Abdelmlak R, Aissa S, Kallel A, Boudawara Y, Bel Hadj S, Ben Romdhane N, Touiri Ben Aissa H, Kallel K. Disseminated histoplasmosis diagnosed in the bone marrow of an HIV-infected patient: First case imported in Tunisia. J Mycol Med 2018. [PMID: 29519625 DOI: 10.1016/j.mycmed.2018.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Histoplasmosis is a fungal infection caused by a dimorphic fungus, Histoplasma capsulatum. We report a first case of disseminated histoplasmosis in a 34-year-old woman, infected with human immunodeficiency virus (HIV), originating from Ivory Coast and living in Tunisia for 4 years. She was complaining from fever, chronic diarrhoea and pancytopenia. The Histoplasma capsulatum var. capsulatum was identified by direct microscopic examination of the bone marrow. She was treated by Amphotericin B, relayed by itraconazole. Even though a regression of symptoms and normalization of blood cell count (BCC), the patient died in a respiratory distress related to CMV hypoxemic pneumonia.
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Affiliation(s)
- N Fakhfakh
- Laboratory of Parasitology-Mycology, Rabta Hospital, Jabbari street, 1007 Tunis, Tunisia; Infectious diseases ward, Rabta Hospital, Tunis, Tunisia
| | - R Abdelmlak
- Infectious diseases ward, Rabta Hospital, Tunis, Tunisia; Université de Tunis El Manar, faculté de médecine de Tunis, Tunis, Tunisia
| | - S Aissa
- Infectious diseases ward, Rabta Hospital, Tunis, Tunisia; Université de Tunis El Manar, faculté de médecine de Tunis, Tunis, Tunisia
| | - A Kallel
- Laboratory of Parasitology-Mycology, Rabta Hospital, Jabbari street, 1007 Tunis, Tunisia; Université de Tunis El Manar, faculté de médecine de Tunis, Tunis, Tunisia
| | - Y Boudawara
- Laboratory of Parasitology-Mycology, Rabta Hospital, Jabbari street, 1007 Tunis, Tunisia; Université de Tunis El Manar, faculté de médecine de Tunis, Tunis, Tunisia
| | - S Bel Hadj
- Laboratory of Parasitology-Mycology, Rabta Hospital, Jabbari street, 1007 Tunis, Tunisia; Université de Tunis El Manar, faculté de médecine de Tunis, Tunis, Tunisia
| | - N Ben Romdhane
- Laboratory of Hematology, Rabta Hospital, Tunis, Tunisia; Université de Tunis El Manar, faculté de médecine de Tunis, Tunis, Tunisia
| | - H Touiri Ben Aissa
- Infectious diseases ward, Rabta Hospital, Tunis, Tunisia; Université de Tunis El Manar, faculté de médecine de Tunis, Tunis, Tunisia
| | - K Kallel
- Laboratory of Parasitology-Mycology, Rabta Hospital, Jabbari street, 1007 Tunis, Tunisia; Université de Tunis El Manar, faculté de médecine de Tunis, Tunis, Tunisia
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Wheat J, Myint T, Guo Y, Kemmer P, Hage C, Terry C, Azar MM, Riddell J, Ender P, Chen S, Shehab K, Cleveland K, Esguerra E, Johnson J, Wright P, Douglas V, Vergidis P, Ooi W, Baddley J, Bamberger D, Khairy R, Vikram H, Jenny-Avital E, Sivasubramanian G, Bowlware K, Pahud B, Sarria J, Tsai T, Assi M, Mocherla S, Prakash V, Allen D, Passaretti C, Huprikar S, Anderson A. Central nervous system histoplasmosis: Multicenter retrospective study on clinical features, diagnostic approach and outcome of treatment. Medicine (Baltimore) 2018; 97:e0245. [PMID: 29595679 PMCID: PMC5895412 DOI: 10.1097/md.0000000000010245] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Central nervous system (CNS) involvement occurs in 5 to 10% of individuals with disseminated histoplasmosis. Most experience has been derived from small single center case series, or case report literature reviews. Therefore, a larger study of central nervous system (CNS) histoplasmosis is needed in order to guide the approach to diagnosis, and treatment.A convenience sample of 77 patients with histoplasmosis infection of the CNS was evaluated. Data was collected that focused on recognition of infection, diagnostic techniques, and outcomes of treatment.Twenty nine percent of patients were not immunosuppressed. Histoplasma antigen, or anti-Histoplasma antibodies were detected in the cerebrospinal fluid (CSF) in 75% of patients. One year survival was 75% among patients treated initially with amphotericin B, and was highest with liposomal, or deoxycholate formulations. Mortality was higher in immunocompromised patients, and patients 54 years of age, or older. Six percent of patients relapsed, all of whom had the acquired immunodeficiency syndrome (AIDS), and were poorly adherent with treatment.While CNS histoplasmosis occurred most often in immunocompromised individuals, a significant proportion of patients were previously, healthy. The diagnosis can be established by antigen, and antibody testing of the CSF, and serum, and antigen testing of the urine in most patients. Treatment with liposomal amphotericin B (AMB-L) for at least 1 month; followed by itraconazole for at least 1 year, results in survival among the majority of individuals. Patients should be followed for relapse for at least 1 year, after stopping therapy.
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Affiliation(s)
| | - Thein Myint
- University of Kentucky School of Medicine, Lexington, Kentucky
| | - Ying Guo
- Emory University Rollins School of Public Health
| | - Phebe Kemmer
- Emory University Rollins School of Public Health
| | | | - Colin Terry
- Indiana University Health, Indianapolis, Indiana
| | - Marwan M. Azar
- Yale University School of Medicine, New Haven, Connecticut
| | - James Riddell
- University of Michigan Health System, Ann Arbor, Michigan
| | - Peter Ender
- St. Luke's University Hospital and Health Network, Bethlehem
| | - Sharon Chen
- Stanford University School of Medicine, Stanford
| | | | | | | | - James Johnson
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Patty Wright
- University of California at San Francisco School of Medicine, San Francisco
| | - Vanja Douglas
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Winnie Ooi
- Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - John Baddley
- University of Alabama- Birmingham, Birmingham, Alabama
| | | | - Raed Khairy
- Sparks Center for Infectious Diseases, Fort Smith, Arkansas
| | | | | | | | - Karen Bowlware
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | - Juan Sarria
- University of Texas Medical Branch, Galveston
| | | | - Maha Assi
- Infectious Disease Consultants, Wichita, Kansas
| | | | - Vidhya Prakash
- Southern Illinois University School of Medicine, Springfield, Illinois
| | - David Allen
- Courage Fund, National University of Singapore, Singapore
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Kauffman CA. Treatment of the Midwestern Endemic Mycoses, Blastomycosis and Histoplasmosis. CURRENT FUNGAL INFECTION REPORTS 2017. [DOI: 10.1007/s12281-017-0281-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Nyalakonda H, Albuerne M, Suazo Hernandez LP, Sarria JC. Central Nervous System Histoplasmosis in Acquired Immunodeficiency Syndrome. Am J Med Sci 2016; 351:177-86. [PMID: 26897273 DOI: 10.1016/j.amjms.2015.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Involvement of the central nervous system (CNS) by Histoplasma capsulatum in AIDS is uncommon and not easily recognized. MATERIALS AND METHODS CNS histoplasmosis cases from our institution were identified by a retrospective chart review from 2004-2014. A thorough literature search was performed for additional cases and their characteristics were compared. Clinical findings, treatment and outcomes are discussed. RESULTS A total of 5 cases from our institution were identified. They had a clinical presentation that included classic signs of meningitis, often with evidence of disseminated involvement, and was typically severe with important neurological impairment. These cases were treated with antifungal agents, including a lipid amphotericin B formulation and azole drugs, but eventually 3 experienced nonresolution of their disease likely because of lack of adherence to therapy and died from their infection. The clinical presentation, treatment and outcome of these cases did not significantly differ from cases found in the review of the literature. CONCLUSIONS Clinicians practicing in endemic areas should be aware of this rare but serious form of histoplasmosis. The recognition of 5 cases of CNS histoplasmosis in AIDS patients from a single institution suggests that histoplasmosis should be included in the differential diagnosis of the CNS complications of AIDS.
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Affiliation(s)
- Harita Nyalakonda
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.
| | - Marisol Albuerne
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
| | | | - Juan C Sarria
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
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Hariri OR, Minasian T, Quadri SA, Dyurgerova A, Farr S, Miulli DE, Siddiqi J. Histoplasmosis with Deep CNS Involvement: Case Presentation with Discussion and Literature Review. J Neurol Surg Rep 2015; 76:e167-72. [PMID: 26251798 PMCID: PMC4520962 DOI: 10.1055/s-0035-1554932] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 04/06/2015] [Indexed: 02/02/2023] Open
Abstract
Central nervous system (CNS) histoplasmosis is rare and difficult to diagnose because it is often overlooked or mistaken for other pathologies due to its nonspecific symptoms. A 32-year-old Hispanic man with advanced acquired immunodeficiency virus presented with altered mental status and reported confusion for the past 3 months. He had a Glasgow Coma Scale of 12, repetitive nonfluent speech, and a disconjugate gaze with a right gaze preference. Lung computed tomography (CT) findings indicated a pulmonary histoplasmosis infection. Magnetic resonance imaging of the brain revealed a ring-enhancing lesion in the left caudate nucleus. A CT-guided left retroperitoneal node biopsy was performed and indicated a benign inflammatory process with organisms compatible with fungal yeast. Treatment with amphotericin B followed by itraconazole was initiated in spite of negative cerebrospinal fluid (CSF) cultures and proved effective in mitigating associated CNS lesions and resolving neurologic deficits. The patient was discharged 3 weeks later in stable condition. Six weeks later, his left basal ganglia mass decreased. Early recognition of symptoms and proper steps is key in improving outcomes of CNS histoplasmosis. Aggressive medical management is possible in the treatment of intracranial deep mass lesions, and disseminated histoplasmosis with CNS involvement can be appropriately diagnosed and treated, despite negative CSF and serology studies.
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Affiliation(s)
- Omid R Hariri
- Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, California, United States
| | - Tanya Minasian
- Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, California, United States
| | - Syed A Quadri
- Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, California, United States
| | - Anya Dyurgerova
- Division of Neurosurgery, Department of Surgery, Western University of Health Sciences, Pomona, California, United States
| | - Saman Farr
- Division of Neurosurgery, Department of Surgery, Western University of Health Sciences, Pomona, California, United States
| | - Dan E Miulli
- Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, California, United States
| | - Javed Siddiqi
- Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, California, United States
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Abstract
Background. Histoplasmosis is a common fungal infection in the southeastern, mid-Atlantic, and central states; however, its presentation can be atypical. Case Presentation. We report a case of Histoplasma capsulatum infection presenting as slowly progressive weakness in the lower extremities, followed by the development of numbness below the midthoracic area, urinary incontinence, and slurred speech. Brain MRI showed leptomeningeal enhancement, predominantly linear, involving the basal cisterns, the brainstem, and spinal cord. Cerebrospinal fluid analysis showed lymphocytic pleocytosis. Discussion. CNS histoplasmosis is usually seen in patients with disseminated histoplasmosis. Isolated CNS histoplasmosis is rarely seen, especially in immunocompetent patients. Conclusions. Histoplasmosis should be considered in the differential diagnosis of patients experiencing slowly progressive neurological deficit.
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11
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Bolen RD, Bushnell CD, Reynolds PS. Acute ischemic strokes from small vessel vasculitis due to disseminated histoplasmosis infection. J Neurol Sci 2015; 352:125-6. [PMID: 25847020 DOI: 10.1016/j.jns.2015.03.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 03/21/2015] [Accepted: 03/23/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Robert D Bolen
- Department of Neurology Wake Forest Baptist Hospital, Winston-Salem NC 27157, United States.
| | - Cheryl D Bushnell
- Department of Neurology Wake Forest Baptist Hospital, Winston-Salem NC 27157, United States
| | - Patrick S Reynolds
- Department of Neurology Wake Forest Baptist Hospital, Winston-Salem NC 27157, United States
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