Disseminated histoplasmosis in an immunocompetent patient from an endemic area

RATIONALE: Disseminated histoplasmosis is a rare fungal infection and most documented cases are in immunocompromised individuals such as those with acquired immunodeficiency syndrome. However, histoplasmosis easily goes unrecognized in immunocompetent populations. PATIENT CONCERNS: We report a rare case of histoplasmosis that was manifested as persistent fever and abnormal liver function in a 45-year-old immunocompetent female from Jiangsu Province. DIAGNOSES: Investigations revealed anemia and thrombocytopenia. Giemsa-stained bone marrow aspirate showed yeast-like cells, suggestive of Histoplasma capsulatum. Wright-stained bone marrow aspirate confirmed the diagnosis. INTERVENTIONS: The patient was treated by amphotericin B (amphotericin B liposome) and itraconazole. OUTCOMES: Our patient responded well to the treatment. LESSONS: Emphasizing histoplasmosis as a cause of fever of unknown origin in an immunocompetent patient, this case highlights the need for an index of suspicion and the importance of prompt diagnosis, as any delay of treatment can be life threatening.