Photo Quiz - February 2019

A 53 year gentleman from Haryana with recently detected HIV 1 presented with complaints of weakness, weight loss and low grade fever for 10-15 days. Investigations revealed Hb 6 gm, WBC - 2800, platelets - 1,69,000, CD4 count- 59, HIV VL - 18,900 copies/ml. VDRL & TPHA was positive.

Contrast CT chest and abdomen did not reveal any significant lymphadenopathy or chest infiltrates.

Peripheral smear is shown:

What is your diagnosis? View Answer

Answer

Budding intra-cellular yeasts consistent with Histoplasma capsulatum are seen.

Histoplasmosis is being increasingly reported from different parts of India, even outside the Ganga-Brahmaputra basin (see CIDS newsletter Dec 2018). Disseminated disease in immune compromised hosts carries a high mortality.

Final diagnosis: (Presumed) Progressive disseminated histoplasmosis in setting of AIDS

Case provided by: Dr Ritu Chadha (Haematopathologist), Dr Ranjit Sah (Infectiou Diseases Fellow), Dr Neha Gupta (ID)