Disseminated histoplasmosis and primary central nervous system lymphoma

Abstract

A 36-year-old man with a previous diagnosis of acquired immune deficiency syndrome was admitted to a hospital complaining of weakness, dry cough, high fever, weight loss and shortness of breath, with onset 10 days earlier [Brazil; date not given]. He was treated for cerebral toxoplasmosis in 1995 and has been given antiretroviral drugs, which he takes irregularly. A chest X-ray showed condensation in the right lung. Computed tomography showed 2 cavitations with thick walls and the presence of multiple nodules disseminated in both lung fields. Two small ulcers were noticed in his left arm. Biopsy from one of the ulcers confirmed the diagnosis of cutaneous histoplasmosis. Intravenous amphotericin B (50 mg/day) was initiated and the patient improved quickly. One morning however, the patient complained of headache, difficulty in swallowing and left hemiparesis. Computed tomography of the brain showed a large cerebral tumour involving the frontal lobe. He developed seizures, which were barely controlled with anticonvulsants, and died a few days later. Postmortem examination confirmed the diagnosis of disseminated histoplasmosis of the lungs, liver, bone marrow, skin and suprarenal glands.