Hemophagocytic syndrome during Histoplasma capsulatum infection.

Abstract

A 50-year-old African patient was admitted for fever, weight loss and generalized cutaneous eruption. The diagnosis of human immunodeficiency virus infection was made (CD4 count: 34 per cubic millimeter). At admission, biological findings were as follows: hemoglobin 8.5 g/dL, platelet count 300310/L, leukocyte count 5310/L with a normal differential, ferritinemia 20,000 UI/L (normal value <200). Ten days after, severe thrombopenia occurred (6310/L) and hemoglobin level fell to 6.4 g/dL. Histological examination of bone marrow evidenced hemophagocytic histiocytosis (Figure 1) and fungal elements in parasizited macrophages (Figure 2). The diagnosis of Histoplasma capsulatum infection was confirmed by blood culture positivity and the presence of yeast forms from the skin biopsy specimen. HEMOPHAGOCYTIC SYNDROME DURING HISTOPLASMA CAPSULATUM INFECTION KADOUDJA CHEMLAL,* VALERIE ANDRIEU-BAUTRU, ANNE COUVELARD° Departments of *Internal Medicine; Hematology and °Pathology, Hopital Bichat, Paris, France