Disseminated Histoplasmosis in a Patient with Human Immunodeficiency Virus Infection

Figure 1. A 37-year-old man who had emigrated to Montreal in 1990 was hospitalized because of a three-week history of high fever and weight loss. He had been given a diagnosis of human immunodeficiency virus infection five years previously but had declined treatment. The results of a physical examination and initial blood tests were unremarkable, except for the finding of mild microcytic anemia. The CD4 count was 130 cells per cubic millimeter. The results of an extended workup, including multiple imaging studies, were negative. During hospitalization, pancytopenia and markedly elevated lactate dehydrogenase levels (up to 7200 U per liter) developed. . . .