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Disseminated histoplasmosis with bone marrow infiltration in a newly diagnosed HIV patient

Summary

A Colombian patient living in Spain developed a serious fungal infection (histoplasmosis) that spread throughout his body and affected his bone marrow, which was discovered during his HIV diagnosis. Doctors identified the infection by examining bone marrow cells under a microscope and confirmed it with fungal culture and genetic testing. The patient was treated with antifungal medication (liposomal amphotericin B) along with HIV medications and recovered well, highlighting the importance of bone marrow testing in severely immunocompromised HIV patients.

Background

Histoplasmosis is a dimorphic fungal infection caused by Histoplasma capsulatum found mainly in humid climate regions, particularly in Latin America. The infection is rare in Spain but can reactivate in severely immunocompromised patients such as those with advanced HIV disease.

Objective

This case report describes the clinical presentation and diagnosis of disseminated histoplasmosis with bone marrow infiltration in a newly diagnosed HIV patient from Colombia living in Spain, emphasizing the diagnostic value of bone marrow aspiration.

Results

The patient presented with pancytopenia, elevated inflammatory markers, positive beta-D-glucan and galactomannan biomarkers, and HIV diagnosis with CD4 count of 67/mcL. Bone marrow aspirate revealed small budding yeasts compatible with Histoplasma capsulatum, confirmed by culture and molecular techniques.

Conclusion

Early bone marrow aspiration is crucial in HIV patients with cytopenias and low CD4 counts for diagnosing disseminated histoplasmosis. Clinicians should consider histoplasmosis in patients from endemic regions despite residing in non-endemic countries, given evolving epidemiology driven by migration and international travel.
  • Published in:Rev Esp Quimioter,
  • Study Type:Case Report,
  • Source: PMID: 40265774, DOI: 10.37201/req/008.2025
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