Presentaciones atípicas de histoplasmosis

RESUMEN Introduccion: La histoplasmosis es una enfermedad granulomatosa, producida por un hongo dimorfo, Histoplasma capsulatum. Tiene una distribucion cosmopolita. Este hongo causa un amplio espectro de manifestaciones clinicas, la mas frecuente es la forma pulmonar. En algunos casos se presentan formas diseminadas, que pueden tener afectacion de uno o multiples organos, de caracteristicas atipicas, dificiles de reconocer. La patogenia de esta enfermedad es igual a la de la tuberculosis y se ha descrito la coinfeccion. Objetivo: Se reportan tres casos de histoplasmosis de presentacion infrecuente: ancianos, coinfeccion con micobacterias y localizaciones atipicas. Se realiza una revision de la literatura. Casos clinicos: El primer caso fue un paciente de 19 anos de edad con un absceso cerebral. El segundo y tercero, fueron personas mayores de 60 anos, con infeccion mixta por Histoplasma y micobacterias, uno de presentacion articular y otra con enfermedad ginecologica. Conclusion: En Venezuela, zona endemica para esta micosis, el medico esta obligado a tener un alto indice de sospecha acerca de la misma, teniendo en cuenta factores como la edad y la epidemiologia. SUMMARY Introduction: Histoplasmosis is a granulomatous disease caused by a dimorphic fungus, Histoplasma capsulatum. It has a cosmopolitan distribution. This fungus causes a wide spectrum of clinical manifestations; the most common is the pulmonary form. Disseminated forms occur, which may affect one or more organs, with atypical features, hard to recognize. The pathogenesis of this condition is similar to tuberculosis and coinfection has been described. Aim: Three cases of unusual presentation of histoplasmosis are reported, including atypical locations of the disease, old adults and coinfection with mycobacteria. A review of the literature was performed. Case report: The first case was a 19 year old patient with a brain abscess. The second and third were people over 60 years, with mixed infection with Histoplasma and mycobacteria, one with a joint presentation and the other with gynecological disease. Conclusion: In Venezuela, endemic area for this mycosis, the physician is required to have a high index of suspicion about it, taking into account factors such as age and epidemiology.