Blood Res 2020; 55(3): 129-129  https://doi.org/10.5045/br.2020.2020134
Peripheral blood histoplasmosis in an immunocompetent child with disseminated disease
Richa Chauhan1, Soma Pradhan1, Jyoti Kotwal1, Kunal Chawla2, Manas Kalra3, Anupam Sachdev3
Departments of 1Hematology, 2Medicine, and 3Pediatric Hematology Oncology, Sir Ganga Ram Hospital, New Delhi, India
Correspondence to: Soma Pradhan, M.D., Department of Hematology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110060, India
E-mail: drsomapradhan21@gmail.com
Received: June 8, 2020; Revised: June 16, 2020; Accepted: June 24, 2020; Published online: August 4, 2020.
© The Korean Journal of Hematology. All rights reserved.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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A 15-year-old female from Uttar Pradesh, India presented to pediatric emergency unit with bilateral joint pain, breathlessness, multiple necrotic skin lesions, and a six-month history of intermittent fever. On examination, she had multiple maculopapular lesions over her whole body and hepatosplenomegaly. Earlier investigations revealed pancytopenia. We considered a clinical diagnosis of lupus. Complete blood count showed hemoglobin 8.5 g/dL, total leucocyte count was 2,220/μL, platelets were 108,000/μL, and the absolute neutrophil count was 1,887/μL. The peripheral blood smear revealed occasional monocytic-macrophage lineage cells with engulfed yeast-like forms of Histoplasma capsulatum (A, MGG, ×100; B, ×40). Bone marrow biopsy showed increased plasma cells and histiocytes with many intracellular and extracellular forms of the fungus (arrow) (C, H&E stain, ×40). Occasional loose clusters of epithelioid histiocytes and foreign body giant cells were noted. Inset (D, ×40) shows fungus on the Gomori methenamine silver stain. The fungus was obtained from skin scraping. She was immediately started on amphotericin B and itraconazole. The immunological workup showed elevated IgG and a normal CD4:CD8 ratio. The workup for chronic granulomatous disease and HIV was negative. Despite dual antifungal therapy she succumbed to disseminated disease. Finding circulating fungal forms is a rare ominous event, especially in immunocompetent hosts.



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