Massive splenomegaly in the course of disseminated histoplasmosis reactivation in an AIDS patient

Abstract

Introduction: Disseminated histoplasmosis is the most frequent form of presentation of this endemic mycosis in AIDS patients. Splenomegaly commonly occurs as a consequence of it, but it is not usually massive.

Objective: To describe an uncommon case of massive splenomegaly caused by disseminated histoplasmosis in an AIDS patient.

Clinical case: The case of an AIDS patient diagnosed 14 years ago is presented. Since diagnosis, the patient has been under antiretroviral treatment irregularly. The first event of this mycosis was 10 years ago. In that occasion, antimitotic treatment was prescribed for four months without secondary prophylaxis. Six months later, symptoms suggestive of reactivation of the disease started. The patient remained symptomatic on a recurrent basis over these years, and attended recently to the hospital in an advanced stage of the disease with large lymphadenopathies and massive hepatosplenomegaly. Diagnostic was confirmed by node biopsy, and antimycotic treatment was indicated, resulting in the resolution of the symptoms and an evident reduction of the enlarged organs.

Conclusions: Massive splenomegaly can be present in this disease. In this case, it should have been originated due to a long reactivation period which was determined by the varying and advanced immunosuppressed state, the irregularity with the antiretroviral treatment, and the lack of secondary prophylaxis for the mycosis.