Miliary tuberculosis and disseminated histoplasmosis in an HIV-negative patient with a low CD4+ lymphocyte counts. A case report

Abstract

A 46 year-old Malay gentleman who was premorbidly well and healthy presented with 3 months history of prolonged fever and marked constitutional symptoms in April 1996. Microbiological and radiological findings were compatible with a diagnosis of disseminated tuberculosis for which he was treated for nine months with anti tuberculous therapy but he defaulted follow up in February 1997. He was readmitted with worsening of his symptoms in 1997. A new problem at that time was multiple skin abscesses form which Histoplasma capsulatum was isolated but tuberculous screening was negative. Lytic lesions were noted on the skull x-ray. Peripheral blood lymphocyte immunophenotyping showed a CD4+ lymphocytopenia. However, screening for antibodies to human immunodeficiency virus (HIV) was negative on 4 occasions. The lytic lesions on the skull disappeared and the psoas and skin abscesses resolved following treatment with anti tuberculous therapy and amphotericin B. However, despite these improvement and haemodynamically he was noted to be stable before his family requested to be discharged. He passed away at home on the next day.