Disseminated histoplasmosis in pediatrics: case series and clinical analysis in a tertiary hospital

Abstract

HistoplasmosisIntroduction: Histoplasmosis is an endemic mycosis caused by Histoplasma capsulatum, a dimorphic fungus that proliferates in soils contaminated with bird and bat droppings, particularly in caves, abandoned buildings, and excavation sites. It is prevalent in Central and South America, where diagnosis is often challenging due to clinical similarities with other diseases such as tuberculosis and visceral leishmaniasis. Description of a series of cases: Case 1: Male, 3 years old, from an urban area, with immunodeficiency due to interleukin-12 receptor deficiency and a history of Mycobacterium bovis infection. He was admitted for intestinal intussusception and, two months later, was readmitted with diarrhea, fever, and hepatomegaly. Histoplasmosis was diagnosed, and amphotericin B was started on day 5 of hospitalization (IH); he died on day 28. Case 2: Male, 14 years old, from a rural area, with a prior history of histoplasmosis and primary immunodeficiency. He presented with abdominal pain, fever, and cervical lymphadenopathy. Reactivation of histoplasmosis was confirmed; itraconazole treatment began on day 17 IH with good clinical evolution. Case 3: Male, 6 years old, from a rural area, with disseminated tuberculosis and histoplasmosis confirmed by culture and urine antigen testing. Combined treatment was initiated on day 20 IH; he died on day 35. Conclusions: The clinical presentation of disseminated histoplasmosis in three immunocompromised children or those exposed to high-risk environments was nonspecific. It is crucial to establish early clinical and epidemiological suspicion in resource-limited settings and regions where diseases such as tuberculosis and visceral leishmaniasis also prevail.