Abstract Background Histoplasmosis is a fungal infection endemic to particular geographic regions, such as the Ohio and Mississippi River valleys. It primarily affects individuals with compromised immune systems. Disseminated histoplasmosis occurring in immunocompetent patients, particularly outside of endemic regions, is uncommon and poses a diagnostic challenge due to its variable and frequently deceptive presentation. Case Presentation We present a case involving an 18-year-old immunocompetent female. She arrived at the emergency department following a syncopal episode, with concern for a seizure. Upon evaluation, she reported experiencing chest pain, palpitations, fever, myalgia, and a sore throat. The initial workup revealed elevated troponin levels, along with a cavitary pulmonary lesion observed on chest computed tomography (CT). She had an abnormal cardiac Magnetic resonance Imaging (MRI) suggesting myocarditis. A comprehensive infectious workup yielded negative results for various conditions, including HIV, tuberculosis, and fungal serologies, except for a positive urine Histoplasma antigen and a positive complement fixation test. Given the multi-organ involvement—including pulmonary, cardiovascular, and neurologic systems—a diagnosis of disseminated histoplasmosis was established. The patient received treatment with oral itraconazole and demonstrated clinical improvement as well as radiologic resolution of the cavitary lung lesion upon follow-up after 2 months. Notably, the patient had no known immunosuppressive conditions or relevant exposures and had relocated from an endemic region (Alabama) five months prior, exceeding the typical incubation period. Conclusion This case highlights the importance of maintaining a heightened index of suspicion for disseminated histoplasmosis, even among immunocompetent individuals and in non-endemic regions. This abstract is funded by: None
Igbokwe et al. (Fri,) studied this question.