Abstract
Progressive disseminated histoplasmosis is a disease where Histoplasma capsulatum affects multiple organs due to the inability of host cellular immunity to control the infection. Progressive disseminated histoplasmosis mainly involves the bone marrow, liver, and lungs. We report an unusual initial presentation of progressive disseminated histoplasmosis presenting as acute tenosynovitis in a systemic lupus erythematosus (SLE) patient. This report highlights the point that H. capsulatum may present as focal lesions and a high level of suspicion is needed to make the diagnosis, especially in SLE patients. We specifically reviewed reported cases of progressive disseminated histoplasmosis in SLE patients, and a review of the literature is presented.
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Weng CT, Lee NY, Liu MF, Weng MY, Wu AB, Chang TW, Lin TS, Wang JY, Chang HY, Wang CR (2010) A retrospective study of catastrophic invasive fungal infections in patients with systemic lupus erythematosus from southern Taiwan. Lupus 19(10):1204–1209. doi:10.1177/0961203310368969
Watson JI, Mandl MA, Rose B (1968) Disseminated histoplasmosis occurring in association with systemic lupus erythematosus. Can Med Assoc J 99(19):958–962
Craig EL, Suie T (1974) Histoplasma capsulatum in human ocular tissue. Arch Ophthalmol 91(4):285–289
Sieving RR, Kauffman CA, Watanakunakorn C (1975) Deep fungal infection in systemic lupus erythematosus—three cases reported, literature reviewed. J Rheumatol 2(1):61–72
Kauffman CA, Israel KS, Smith JW, White AC, Schwarz J, Brooks GF (1978) Histoplasmosis in immunosuppressed patients. Am J Med 64(6):923–932
Navarro EE, Tupasi TE, Verallo VM, Romero RC, Tuazon CU (1992) Disseminated histoplasmosis with unusual cutaneous lesions in a patient from the Philippines. Am J Trop Med Hyg 46(2):141–145
Hansen KE, St Clair EW (1998) Disseminated histoplasmosis in systemic lupus erythematosus: case report and review of the literature. Semin Arthritis Rheum 28(3):193–199
Sullivan AA, Benson SM, Ewart AH, Hogan PG, Whitby RM, Boyle RS (1998) Cerebral histoplasmosis in an Australian patient with systemic lupus erythematosus. Med J Aust 169(4):201–202
Isotalo PA, McCarthy AE, Eidus L (2000) Ovarian histoplasmosis in systemic lupus erythematosus. Pathology 32(2):139–141
Price DA, Ong EL (2003) Cutaneous histoplasmosis in a patient with systemic lupus erythematosis. Lancet Infect Dis 3(5):296
Ceccato F, Gongora V, Zunino A, Roverano S, Paira S (2007) Unusual manifestation of histoplasmosis in connective tissue diseases. Clin Rheumatol 26(10):1717–1719. doi:10.1007/s10067-007-0655-5
Cairoli E, Tafuri J, Olivari D (2010) Laryngeal histoplasmosis in systemic lupus erythematosus: first reported case. Lupus 19(11):1354–1355. doi:10.1177/0961203310375267
Pfaller MA, Kyriakos M, Weeks PM, Kobayashi GS (1985) Disseminated histoplasmosis presenting as an acute tenosynovitis. Diagn Microbiol Infect Dis 3(3):251–255
Cucurull E, Sarwar H, Williams CS, Espinoza LR (2005) Localized tenosynovitis caused by Histoplasma capsulatum: case report and review of the literature. Arthritis Rheum 53(1):129–132. doi:10.1002/art.20918
Kauffman CA (2007) Histoplasmosis: a clinical and laboratory update. Clin Microbiol Rev 20(1):115–132. doi:10.1128/CMR.00027-06
Goodwin RA Jr, Shapiro JL, Thurman GH, Thurman SS, Des Prez RM (1980) Disseminated histoplasmosis: clinical and pathologic correlations. Medicine 59(1):1–33
Wheat LJ, Freifeld AG, Kleiman MB, Baddley JW, McKinsey DS, Loyd JE, Kauffman CA (2007) Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis Off Publ Infect Dis Soc Am 45(7):807–825. doi:10.1086/521259
Furcolow ML (1963) Comparison of treated and untreated severe histoplasmosis. JAMA: J Am Med Assoc 183(10):823–829. doi:10.1001/jama.1963.03700100049008
Porta AMB (2000) Host response and Histoplasma capsulatum/macrophage molecular interactions. Med Mycol: Off Publ Int Soc Human Anim Mycol 38(6):399–406
Petri M (1998) Infection in systemic lupus erythematosus. Rheum Dis Clin N Am 24(2):423–456
Staples PJ, Gerding DN, Decker JL, Gordon RS Jr (1974) Incidence of infection in systemic lupus erythematosus. Arthritis Rheum 17(1):1–10
Bosch X, Guilabert A, Pallares L, Cerveral R, Ramos-Casals M, Bove A, Ingelmo M, Font J (2006) Infections in systemic lupus erythematosus: a prospective and controlled study of 110 patients. Lupus 15(9):584–589
Iliopoulos AG, Tsokos GC (1996) Immunopathogenesis and spectrum of infections in systemic lupus erythematosus. Semin Arthritis Rheum 25:318–336
Joseph Wheat L (2003) Current diagnosis of histoplasmosis. Trends Microbiol 11(10):488–494
Martagon-Villamil J, Shrestha N, Sholtis M, Isada CM, Hall GS, Bryne T, Lodge BA, Reller LB, Procop GW (2003) Identification of Histoplasma capsulatum from culture extracts by real-time PCR. J Clin Microbiol 41(3):1295–1298
Kauffman CA (2009) Histoplasmosis. Clin Chest Med 30(2):217–225. doi:10.1016/j.ccm.2009.02.002, v
Tada Y, Sadakata M, Koarada S, Ushiyama O, Suzuki N, Ohta A, Nagasawa K (2000) Flexor tenosynovitis of the hands as an initial manifestation of systemic lupus erythematosus. Mod Rheumatol 10(3):173–175
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Lim, S.Y., Kijsirichareanchai, K. & Winn, R. Progressive disseminated histoplasmosis in systemic lupus erythematosus—an unusual presentation of acute tenosynovitis and a literature review. Clin Rheumatol 32, 135–139 (2013). https://doi.org/10.1007/s10067-012-2102-5
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DOI: https://doi.org/10.1007/s10067-012-2102-5