Program Schedule

Histoplasmosis-induced Hemophagocytic Syndrome: A Case Series

Session: Poster Abstract Session: Fungal Infections
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Sparse clinical data exist regarding the course and outcomes of histoplasmosis-associated hemophagocytic lymphohistiocytosis (HLH) in adults.  Data from this decade are limited to case reports. The objective of this study is to describe the clinical features, treatment, and outcomes of patients with histoplasmosis-associated (HLH) at our institution in the past decade.

Methods: We performed a retrospective chart review study of all inpatients at Parkland Memorial Hospital diagnosed with HLH associated with Histoplasma capsulatum from 2003-2013.  

Results: Eleven cases of histoplasmosis-associated HLH over this time period were available for review. 9 of 11 cases were males (82%) with a mean age of 46.8 years. 9 had AIDS with a CD4 <100 cells/mm3, one was a renal transplant, and the last had no immune compromise.  The most frequently seen HLH criteria were splenomegaly (n=10), fever (n=10), and a ferritin >500 ng/dL (n=8). The urine Histoplasma antigen was positive in every patient examined (n=9/11), and most antibodies for Histoplasma were positive if checked (n=4/5). Blood culture and bone marrow yielded the highest positive cultures (64% and 54% respectively). Four of the HIV patients were on HAART at diagnosis. A majority of patients received liposomal amphotericin B during their hospital stay (n=9) with average duration of treatment being 11 days. Five patients received immunosuppressive treatments during admission, including prednisone and IVIG. Five patients died within 30 days (45.5%), and seven within 90 days (63.6%). Of the 5 patients that received immunosuppression, 4 died (80%), whereas in the group not given additional immunosuppression (n=5), only 2 died (20%).

Conclusion: We describe the largest case series to date of HLH related to histoplasmosis. Clinicians should consider this diagnosis in HIV+ and other immunocompromised patients  in endemic areas with the clinical features described. Histoplasmosis-associated HLH among adults remains a lethal disease of highly immune compromised patients.

Jennifer Holmes, MD1, John Hancock, MS42, Kathryn Bowman, MS42 and Ank Nijhawan, MD, MPH3, (1)Infectious Disease, University of Texas Southwestern Medical Center, Dallas, TX, (2)University of Texas Southwestern, Dallas, TX, (3)Internal Medicine/Infectious Diseases, UT Southwestern Medical Center, Dallas, TX


J. Holmes, None

J. Hancock, None

K. Bowman, None

A. Nijhawan, None

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