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Cave diving for a diagnosis: Disseminated histoplasmosis in the immunocompromised

Tumor necrosis factor (TNF) inhibitors are widely used in the treatment of inflammatory conditions and are associated with risks of invasive infections. We present a diagnostically challenging patient with unique comorbidities and travel history. A 53-year-old man with a history of polysubstance abu...

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Autores principales: Mirza, Abu-Sayeef, Vega, Vivian R
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010963/
https://www.ncbi.nlm.nih.gov/pubmed/29942759
http://dx.doi.org/10.1016/j.idcr.2018.03.020
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author Mirza, Abu-Sayeef
Vega, Vivian R
author_facet Mirza, Abu-Sayeef
Vega, Vivian R
author_sort Mirza, Abu-Sayeef
collection PubMed
description Tumor necrosis factor (TNF) inhibitors are widely used in the treatment of inflammatory conditions and are associated with risks of invasive infections. We present a diagnostically challenging patient with unique comorbidities and travel history. A 53-year-old man with a history of polysubstance abuse and psoriasis on adalimumab presented to our hospital directly from the airport with fever, dyspnea, and cough. He had been living in Costa Rica and engaged in many outdoor activities. Within 6 h and a limited history, he was intubated; vasopressors and antimicrobials were promptly administered. An extensive infectious disease investigation was undertaken, considering potential travel-related exposures and his immunosuppressive state. However, multi-organ failure with worsening disseminated intravascular coagulation ensued, and within four days of admission, the patient passed away. Five days after his death, the urine Histoplasma antigen resulted positive. Disseminated histoplasmosis should be suspected in a patient on anti-TNF therapy, with a severe febrile illness and pneumonia refractory to antibacterial therapy. A high index of suspicion is necessary to make the diagnosis and initiate prompt treatment.
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spelling pubmed-60109632018-06-25 Cave diving for a diagnosis: Disseminated histoplasmosis in the immunocompromised Mirza, Abu-Sayeef Vega, Vivian R IDCases Article Tumor necrosis factor (TNF) inhibitors are widely used in the treatment of inflammatory conditions and are associated with risks of invasive infections. We present a diagnostically challenging patient with unique comorbidities and travel history. A 53-year-old man with a history of polysubstance abuse and psoriasis on adalimumab presented to our hospital directly from the airport with fever, dyspnea, and cough. He had been living in Costa Rica and engaged in many outdoor activities. Within 6 h and a limited history, he was intubated; vasopressors and antimicrobials were promptly administered. An extensive infectious disease investigation was undertaken, considering potential travel-related exposures and his immunosuppressive state. However, multi-organ failure with worsening disseminated intravascular coagulation ensued, and within four days of admission, the patient passed away. Five days after his death, the urine Histoplasma antigen resulted positive. Disseminated histoplasmosis should be suspected in a patient on anti-TNF therapy, with a severe febrile illness and pneumonia refractory to antibacterial therapy. A high index of suspicion is necessary to make the diagnosis and initiate prompt treatment. Elsevier 2018-04-03 /pmc/articles/PMC6010963/ /pubmed/29942759 http://dx.doi.org/10.1016/j.idcr.2018.03.020 Text en © 2018 The Authors. Published by Elsevier Ltd. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Article
Mirza, Abu-Sayeef
Vega, Vivian R
Cave diving for a diagnosis: Disseminated histoplasmosis in the immunocompromised
title Cave diving for a diagnosis: Disseminated histoplasmosis in the immunocompromised
title_full Cave diving for a diagnosis: Disseminated histoplasmosis in the immunocompromised
title_fullStr Cave diving for a diagnosis: Disseminated histoplasmosis in the immunocompromised
title_full_unstemmed Cave diving for a diagnosis: Disseminated histoplasmosis in the immunocompromised
title_short Cave diving for a diagnosis: Disseminated histoplasmosis in the immunocompromised
title_sort cave diving for a diagnosis: disseminated histoplasmosis in the immunocompromised
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010963/
https://www.ncbi.nlm.nih.gov/pubmed/29942759
http://dx.doi.org/10.1016/j.idcr.2018.03.020
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