Disseminated histoplasmosis in a human immunodeficiency virus-infected African child.

Progressive disseminated histoplasmosis (PDH) a recognized defining illness of AIDS is an opportunistic fungal infection caused by Histoplasma capsulatum. The authors report a case of PDH in a HIV-infected African child from a Histoplasma capsulatum non-endemic area. An 8-year-old girl from Kwazulu/Natal South Africa was admitted to King Edward VIII hospital with pyrexia and respiratory distress. Pale with generalized lymphadenopathy she had been sick with general malaise and fever for 3 weeks. A punched-out painless ulcer was present on the childs lower left leg and she had ulcerative lesions on the tip of her tongue and the angle of her mouth. There was a tender hepatomegaly and clinical signs of pneumonia while a chest roentgenogram showed right upper lobe consolidation with early cavitation. The purified protein derivative tuberculin skin test was negative and no acid-fast bacilli were detected on three sputum samples taken on different days. A Western blot test conducted for antibodies to HIV was positive. Additional laboratory tests were conducted. The patient was treated with parenteral acyclovir for herpesvirus infection ceftriaxone for severe community-acquired pneumonia and trimethoprim-sulfamethoxazole because Pneumocystis carinii infection was part of the clinical differential diagnosis. Bone marrow aspirate and trephine biopsy revealed yeast forms of H. capsulatum. The girl died on the second day of hospital admission before antifungal therapy could be commenced.