Fatal disseminated histoplasmosis in a Nigerian woman: A case report

Abstract

Disseminated histoplasmosis (DH) is the most severe clinical presentation of histoplasmosis, commonly associated with the advanced HIV disease (AHD) population. Our case report highlights the need for the deployment of point of care test kits for the diagnosis of histoplasmosis in resource limited settings including Africa and Nigeria in particular. Our case is a 56-year-old HIV positive (CD4 count of < 200 cells/microliter) Nigerian woman with complaints of cough, weight loss and easy fatigability all of several month’s duration, who had self-interrupted her care prior to the onset of presenting complaints. The anti-TB regimen was commenced based on chest CT and chest X-ray findings despite negative GeneXpert results while awaiting urine Histoplasma antigen assay results. A positive Histoplasma antigen assay was communicated to the attending clinician 2 weeks after patient’s demise. Delays in the diagnosis of disseminated histoplasmosis in our locality is a major factor contributing to fatal outcomes. The availability of point of care kits for the detection of Histoplasma in our facilities will aid in prompt diagnosis and invariably avert preventable deaths.

Keywords

• disseminated histoplasmosis
• tuberculosis
• hiv/aids