Histoplasma Meningitis

Histoplasmosis tends to mimic tuberculosis in most of its manifestations; however, involvement of the central nervous system with Histoplasma capsulatum has been rarely recorded. It has been suggested that it might be more frequently found if autopsies of fatal histoplasmosis cases were done with more attention to examination of the brain. 1-2 Schulz 1 reviewed 120 autopsied cases of histoplasmosis and found Histoplasma involvement of the brain or meninges in 12 of them. Similarly, Shapiro, Lux, and Sprofkin 2 found miliary granulomas, focal destructive lesions, or leptomeningitis in 6 of 11 autopsies of patients who died of this disease. Only 5 cases of clinical meningitis ascribed to H. capsulatum have been recorded to our knowledge. Duarte, 3 in 1945, reported the case of a 23-year-old woman with headache, photophobia, nausea, and vomiting but no signs of meningeal irritation. At autopsy, the patient had a basilar meningeal exudate and lesions in