Histoplasmosis of man has been known hitherto only from the three cases reported by Darling, from Panama.
A fourth case is here reported—that of a woman who had not been out of the State of Minnesota in forty-two years.
The case was clinically identical with those reported by Darling: greatly enlarged spleen, pseudo-granuloma of the lungs, emaciation, and anemia.
In phagocytic cells of the lung, liver, spleen, and lymph nodes were enormous numbers of the organism described by Darling under the name Histoplasma capsulatum.
As pointed out by da Rocha Lima (1912) this organism is evidently closely related to Cryptococcus farciminosus Rivolta, the cause of epizootic lymphangitis of horses and man. While da Rocha Lima and most recent workers regard this organism as a yeast, Ota (1925) places it in the genus Grubyella, among the Hyphomycetes. Most of the mycoses which become systemic are rapidly fatal. This condition was systemic and chronic for many years.
The available evidence does not support the view that histoplasmosis of man is identical with epizootic lymphangitis.
In clinical picture and in size and morphology of the organisms it differs from the torulosis of Stoddard and Cutler, cases of which have been noted especially in the vicinity of Chicago, Illinois.
The probability is that in histoplasmosis and in epizootic lymphangitis we are dealing with two very closely related species of Cryptococcus (Grubyella), one causing systemic infection and one largely superficial. An analogous situation is afforded by Leishmania donovani and Leishmania tropica.
The finding of this case emphasizes the importance of considering the possibilities of the disease in connection with obscure cases of splenomegaly in temperate as well as in tropical zones.