Histoplasmosis among HIV-infected patients in Japan: A case report and literature review

Abstract

Histoplasmosis is occasionally encountered in non-endemic countries owing to more frequent international travel and migration, as well as to an increase in the number of vulnerable hosts (e.g., patients with cellular immunodeficiencies). However, diagnosis of endemic mycoses may be challenging owing to its rarity and the limited availability of diagnostic tests. We report a case of disseminated histoplasmosis in a human immunodeficiency virus (HIV)-infected Japanese man who had often travelled to histoplasmosis-endemic countries. We also reviewed the reported cases of HIV-associated histoplasmosis in Japan. To the best of our knowledge, this is the ninth case report of co-infection with Histoplasma and HIV in Japan, and the second involving a Japanese patient. This case emphasizes the importance of noting the details of not only the present residence of patients but also their previous residence and travels. If histoplasmosis is suspected, physicians should inform laboratory personnel that fungal cultures should be incubated for 6 weeks, and compliance with biosafety guidelines for handling the specimens should be practiced. Since death occurred in nearly 50% of HIV-associated histoplasmosis in Japan, early recognition, timely diagnosis, and appropriate treatment are mandatory.