Volume 100, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We describe a Venezuelan visitor to Japan who was diagnosed with hemophagocytic lymphohistiocytosis (HLH). The patient was also diagnosed with human immunodeficiency virus (HIV) and Epstein–Barr virus infection by the Western blot and polymerase chain reaction (PCR) tests, respectively. The cause of HLH was considered to be these two infections at first; however, the patient did not recover with antiretroviral/anti-herpes virus therapy. Thereafter, diagnosis of disseminated histoplasmosis was confirmed with an antigen detection test, culture, and PCR test of blood, urine, and bone marrow, and the patient improved gradually after the initiation of liposomal amphotericin B. This case highlights the importance of ruling out endemic mycosis as a cause of HLH even if other probable causes exist in patients from endemic areas.


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  1. Ramos-Casals M, Brito-Zeron P, Lopez-Guillermo A, Khamashta MA, Bosch X, 2014. Adult haemophagocytic syndrome. Lancet 383: 15031516.
    [Google Scholar]
  2. Fardet L et al., 2010. Reactive haemophagocytic syndrome in 58 HIV-1-infected patients: clinical features, underlying diseases and prognosis. AIDS 24: 12991306.
    [Google Scholar]
  3. Baddley JW, Sankara IR, Rodriquez JM, Pappas PG, Many WJ Jr., 2008. Histoplasmosis in HIV-infected patients in a southern regional medical center: poor prognosis in the era of highly active antiretroviral therapy. Diagn Microbiol Infect Dis 62: 151156.
    [Google Scholar]
  4. Tobon AM, Agudelo CA, Rosero DS, Ochoa JE, De Bedout C, Zuluaga A, Arango M, Cano LE, Sampedro J, Restrepo A, 2005. Disseminated histoplasmosis: a comparative study between patients with acquired immunodeficiency syndrome and non-human immunodeficiency virus-infected individuals. Am J Trop Med Hyg 73: 576582.
    [Google Scholar]
  5. Sathapatayavongs B, Batteiger BE, Wheat J, Slama TG, Wass JL, 1983. Clinical and laboratory features of disseminated histoplasmosis during two large urban outbreaks. Medicine (Baltimore) 62: 263270.
    [Google Scholar]
  6. Gil-Brusola A, Peman J, Santos M, Salavert M, Lacruz J, Gobernado M, 2007. Disseminated histoplasmosis with hemophagocytic syndrome in a patient with AIDS: description of one case and review of the Spanish literature. Rev Iberoam Micol 24: 312316.
    [Google Scholar]
  7. Cermeno JR, Cermeno JJ, Hernandez I, Godoy G, Cermeno JJ, Cabello I, Orellan Y, Blanco Y, Penna S, 2005. Histoplasmine and paracoccidiodine epidemiological study in Upata, Bolivar state, Venezuela. Trop Med Int Health 10: 216219.
    [Google Scholar]
  8. Cermeno JR et al., 2004. Epidemiological survey of histoplasmine and paracoccidioidine skin reactivity in an agricultural area in Bolivar state, Venezuela. Eur J Epidemiol 19: 189193.
    [Google Scholar]
  9. Colombo AL, Tobon A, Restrepo A, Queiroz-Telles F, Nucci M, 2011. Epidemiology of endemic systemic fungal infections in Latin America. Med Mycol 49: 785798.
    [Google Scholar]
  10. Conces DJ Jr., Stockberger SM, Tarver RD, Wheat LJ, 1993. Disseminated histoplasmosis in AIDS: findings on chest radiographs. AJR Am J Roentgenol 160: 1519.
    [Google Scholar]

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  • Received : 07 Jun 2018
  • Accepted : 16 Sep 2018
  • Published online : 14 Jan 2019
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