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Histoplasmosis (Darling) Without Splenomegaly

A case of lymphadenitis in which fungi were found in the abdominal lymph nodes, spleen, liver, intestine and lungs is recorded.

The organisms encountered and the pathology produced resemble more closely the findings reported in cases of Darling's histoplasmosis than of any other condition known to the writers. It would thus appear that the present report marks the fifth case of histoplasmosis to be reported to medical science, and the second to be recorded in North America.

Two differences between this and previous cases are apparent, however.

1. The spleen of this case was not enlarged at any time, whereas, splenomegaly has been a constant characteristic in the four other cases. This case did exhibit an acute colitis and had death not resulted so early it is possible that the spleen eventually would have become enlarged.

2. In addition to the small intracellular phase of the organism reported by previous workers, a second or extracellular phase is recorded in which the organism is surrounded by a "halo" or capsule of considerable thickness. Whether this is a true capsule or a reaction product of the tissue is uncertain but comparison of this structure with the capsules formed by yeast-like stages of other fungi leads to the conclusion that it probably is a mucinoid capsule, produced by the organism itself.