Disseminated Histoplasmosis with Haemophagocytic Lymphohistiocytosis in an Immunocompetent Patient – A Rare Complication

We present a rare case of disseminated histoplasmosis with haemophagocytic lymphohistiocytosis (HLH) in an immunocompetent individual. A 41-year-old female presented with a persistent fever, on and off for 2 months associated with weight loss, generalised weakness and shortness of breath on exertion. She had hepatosplenomegaly and pancytopaenia. After exclusion of routine causes of fever, a bone marrow evaluation was performed which was suggestive of histoplasmosis with features of haemophagocytosis. Urinary histoplasma antigen was positive. She was successfully treated with a combination of liposomal amphotericin B, intravenous immunoglobulins (IVIG), steroids and later itraconazole.