Introduction: Disseminated histoplasmosis is a neglected tropical disease that is poorly documented in C？te d’Ivoire. The authors report two cases of disseminated African histoplasmosis in HIV-negative local patients residing in C？te d’Ivoire. Case Report: The patients were adults aged 46 and 31. Clinical examination revealed inflammatory swelling of the left shoulder in one patient, and left hip pain accompanied by fever and progressive weight loss in the other. Imaging studies showed osteolysis of the humeral head, iliac wings, and sacrum, associated with abscesses in the periarticular muscles and the left iliopsoas muscle. A diagnosis of histoplasmosis was suspected based on positive tests (lateral flow assay and enzyme immunoassay) for Histoplasma urinary antigen and direct examination revealing large, thick-walled yeast cells. Culture and genomic sequencing of the recovered strain confirmed the organism to be Histoplasma capsulatum var. duboisii. Specific treatment was initiated, consisting of intravenous liposomal amphotericin B followed by itraconazole. Clinical outcomes were favorable in both cases. Conclusion: These two cases underscore the importance of evaluating histoplasmosis in patients presenting clinical features suggestive of tuberculosis, even when mycobacterial investigations are negative, to reduce diagnostic delay.
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