Progressive disseminated histoplasmosis presenting with cachexia and hypercalcemia

ogressive disseminated histoplasmosis presenting with cachexia and hypercalcemia Case report (414) Total Article Views Authors: Khasawneh FA, Ahmed S, Halloush RA Published Date February 2013 Volume 2013:6 Pages 79 - 83 DOI: http://dx.doi.org/10.2147/IJGM.S41520 Received: 12 December 2012 Accepted: 07 January 2013 Published: 27 February 2013 Faisal A Khasawneh,1 Subhan Ahmed,2 Ruba A Halloush3 1Section of Infectious Diseases, Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, 2Section of Nephrology, Department of Internal Medicine, University of Oklahoma, Tulsa, OK, 3Amarillo Pathology Group, Amarillo, TX, USA Abstract: Histoplasmosis is a common endemic mycosis. The majority of infections involving this dimorphic fungus are asymptomatic. Manifestations in symptomatic patients are diverse, ranging from flu-like illness to a more serious disseminated disease. We present here a case of chronic disseminated histoplasmosis mimicking a metastatic cancer. We reviewed the literature for cases of disseminated histoplasmosis presenting with hypercalcemia, focusing particularly on clinical presentation, risk factors predisposing for fungal infection, and outcome. We report a case of a 65-year-old diabetic male who presented with unexplained weight loss and hypercalcemia. Multiple brain space-occupying lesions and bilateral adrenal enlargement were evident on imaging studies. Biopsies showed caseating granulomas with budding yeast, consistent with histoplasmosis. The patient's symptoms resolved after liposomal amphotericin B and itraconazole therapy. Granulomatous diseases, including fungal infections, should be considered alongside malignancies, in patients with similar presentation.