Table 4.
Cases of histoplasmosis-associated histiocytic lymphohistiocytosis (HLH) in the literature.
| Author | Year | Country | Age, gender | Underlying disease | CD4 | Treatment | Histoplasma diagnosis | Outcome∗ |
|---|---|---|---|---|---|---|---|---|
| Majluf-Cruz et al. [5] | 1993 | Mexico | 37 y, M | HIV | NR | Fluconazole | Liver Bx | Survived |
| 49 y, M | HIV | NR | Amphotericin B | BM Bx | Survived | |||
| 36 y, M | HIV | NR | None | BM Bx | Died (N/A) | |||
|
| ||||||||
| Keller and Kurtzberg [6] | 1994 | USA | 6 y | Chronic mucocutaneous candidiasis | N/A | Amphotericin B | BM Cx/blood Cx/BAL Cx | Survived |
|
| ||||||||
| Koduri et al. [7] | 1995 | USA | NR | None | N/A | Amphotericin B/solumedrol | NR | Died (NR) |
|
| ||||||||
| Koduri et al. [8] | 1995 | USA | NR | HIV | 36 | Amphotericin B/IVIG × 2d | Blood smear/BM path and Cx | Died (NR) |
| HIV | 4 | Amphotericin B/IVIG × 2d | Blood smear/BM path/BM Cx/CSF Cx | Died (HD 6) | ||||
| HIV | 6 | Amphotericin B/IVIG × 2d | Blood smear/BM path and Cx | Died (NR) | ||||
| HIV | 22 | Amphotericin B/IVIG × 2d | BM path and Cx/skin Cx | Survived | ||||
| HIV | 32 | Amphotericin B | BM path and Cx | Survived | ||||
| HIV | 44 | Amphotericin B | BM path and Cx | Survived | ||||
|
| ||||||||
| Chemlal et al. [9] | 1997 | Africa | 50 y | HIV | 34 | NR | Blood Cx/BM and skin path | NR |
|
| ||||||||
| Kumar et al. [10] | 2000 | India | 50 y, M | None | N/A | None | Splenic aspirate smears | Died (within 48 hours) |
|
| ||||||||
| 40 y, M | HIV | NR | None | LN Bx | Died (within 48 hours) | |||
|
| ||||||||
| Rao et al. [1] | 2002 | USA | 68 y, M | CLL on cyclophosphamide and fludarabine | N/A | Amphotericin B | BM and lung Bx (path) | Survived |
|
| ||||||||
| Masri et al. [11] | 2003 | USA | 47 y, M | Heart transplant | N/A | Liposomal amphotericin B | BM (path and Cx)/peripheral smear/lung Bx (path and Cx) | Survived |
|
| ||||||||
| Gil-Brusola et al. [12] | 2007 | Ecuador | 33 y, M | HIV/disseminated TB | 39 | None | Blood smear/BM path | Died (HD 18) |
|
| ||||||||
| Guiot et al. [13] | 2007 | Puerto Rico | 43 y, M | HIV/ileal perforation | 66 | Liposomal amphotericin B for 21 days/itraconazole | GI (path)/BAL (cytology)/BM path and Cx, histoplasma PCR | Survived |
|
| ||||||||
| Sanchez et al. [14] | 2007 | USA | 61 y, M | HIV/pulmonary TB | 4 | Amphotericin B | Blood and BM (? Cx or path) | Survived |
|
| ||||||||
| Wang et al. [15] | 2007 | USA | 52 y, M | HCV, CKD | N/A | None (postmortem diagnosis) | Autopsy diagnosis/postmortem blood and spleen Cx | Died (HD 12) |
|
| ||||||||
| Phillips et al. [16] | 2008 | USA | 69 y, M | Sarcoidosis on chronic steroids | N/A | Amphotericin B/steroids/etoposide/cyclosporine | BM path and Cx/blood smear | Survived |
|
| ||||||||
| De Lavaissiere et al. [17] | 2009 | France | 33 y, M | HIV | NR | Amphotericin B/itraconazole/ART/IVIG | Blood and BM (Cx or path?) | Survived |
|
| ||||||||
| Lo et al. [18] | 2010 | USA | 22 y, F | Renal transplant | N/A | Liposomal amphotericin for 2 weeks/itraconazole | BM path/Blood Cx/urine Ag | Survived |
| USA | 18 y, M | Renal transplant | N/A | Liposomal amphotericin B for 1 week/itraconazole | LN path/BM Cx/urine Ag | Survived | ||
|
| ||||||||
| van Koeveringe and Brouwer [19] | 2010 | Holland | 50 y, M | CLL-alemtuzumab/fludarabine/cyclophosphamide | N/A | Dexamethasone/cyclosporine/etoposide/amphotericin B | BM path confirmed by PCR and culture | Survived |
|
| ||||||||
| Vaid and Patel [20] | 2011 | UK | 25 y, M | HIV | 153 | Antifungal | Skin/BM/oral mucosa path | Died (NR) |
|
| ||||||||
| Chandra et al. [21] | 2012 | India | 38 y, F | HIV | NR | Ketoconazole | NR | Survived |
|
| ||||||||
| Nieto-Rios et al. [22] | 2012 | Colombia | 30 y, F | Renal transplant | N/A | Amphotericin B/itraconazole | Blood Cx | Survived |
|
| ||||||||
| 41 y, F | Renal transplant | N/A | None (died the same day of positive Cx) | Blood Cx | Died (HD 3) | |||
|
| ||||||||
| Telfer and Gulati [23] | 2012 | USA | 28 y, M | HIV | 12 | Voriconazole | BM path/urine Ag | Died (NR) |
|
| ||||||||
| Huang [24] | 2014 | Guatemala | 25 y, M | HIV | 4 | Antifungals/dexamethasone | Urine Ag/BM path | Survived |
|
| ||||||||
| Subedee and van Sickels [25] | 2015 | USA | 42 y, F | HIV | 40 | Liposomal amphotericin B/itraconazole | Urine Ag/BM path | Survived |
|
| ||||||||
| Rajput et al. [26] | 2015 | Canada | 64 y, F. | CKD, SCD | N/A | Antifungal therapy | BM and blood Cx | Survived |
|
| ||||||||
| Kashifet al. [27] | 2015 | USA | 34 y, M | SCD | N/A | Amphotericin B/itraconazole/dexamethasone/etoposide | LN Bx | Died (HD 8) |
|
| ||||||||
| Castelliet al. [28] | 2015 | Mexico | 32 y, M | HIV | 3 | Liposomal amphotericin B × 2 weeks/itraconazole/dexamethasone/etoposide | BAL Cx/Blood Cx/BM Cx | Survived |
|
| ||||||||
| Mukherjee and Basu [29] | 2015 | India | 52, M | COPD, Type II DM | N/A | Amphotericin B | Autopsy | Died (NR) |
|
| ||||||||
| Townsend et al. [30] | 2015 | Mexico | 31 y, F | HIV | 1 | Liposomal amphotericin B | Blood and BM Cx | Died (HD 16) |
| USA | 53 y, M | HIV | 6 | Liposomal amphotericin B × 14 d/itraconazole | Urine Ag | Survived | ||
| USA | 33 y, F | HIV | 1 | Liposomal amphotericin B × 21 d/fluconazole | Blood Cx/urine Ag | Survived | ||
| Mexico | 47 y, M | Immunosuppressive treatment | Itraconazole | Urine Ag | Survived | |||
| USA | 28 y, M | HIV | N/A | NR | Blood Cx/BM Cx/urine Ag | Survived | ||
| USA | 60 y, M | Immunosuppressive treatment | N/A | Liposomal amphotericin B/voriconazole/steroids/tacrolimus | BM path/skin Bx/urine Ag | Survived | ||
| USA | 44 y, M | HIV | 2 | Liposomal amphotericin B × 16 d/itraconazole | Sputum and blood Cx/urine Ag | Survived | ||
| USA | 52 y, M | HIV | 16 | Liposomal amphotericin B × 6 d/itraconazole/steroids/IVIG | BM Cx and urine Ag | Died (HD 9) | ||
| USA | 52 y, M | HIV | 16 | Liposomal amphotericin B × 3 d/itraconazole/IVIG | Blood Cx/BM path/urine Ag | Died (HD 9) | ||
| El Salvador | 32 y, M | HIV | 50 | Liposomal amphotericin B × 18 d/itraconazole | Blood, sputum, and BM Cx | Survived | ||
| USA | 51 y, M | HIV | 9 | Liposomal amphotericin B/steroids | Sputum, blood, gastric tissue Cx | Died (HD 13) | ||
|
| ||||||||
| De and Nath [31] | 2015 | India | 40 y, M | Healthy | N/A | Amphotericin B deoxy/itraconazole | BM Bx | Survived |
| 32 y, M | Healthy | N/A | Amphotericin B/itraconazole | BM Bx | Survived | |||
|
| ||||||||
| Sonavane et al. [32] | 2016 | India | 43 y, F | Healthy | N/A | Amphotericin B/itraconazole | BM Bx | Survived |
|
| ||||||||
| Nieto et al. [33] | 2016 | Colombia | 33 y, M | HIV | N/A | Amphotericin B/steroids | NR | Survived |
|
| ||||||||
| Ferguson-Paulet al. [34] | 2016 | USA | 6 months, F | MRSA bacteremia | N/A | Liposomal amphotericin B/itraconazole/etoposide/steroids | Urine serum Ag/BM and CSF Cx | Survived |
|
| ||||||||
| Daoand He [35] | 2016 | USA | 21 y, M | Crohn disease | N/A | Antifungal therapy | BM (cx and path)/Blood and BAL Cx | Survived |
|
| ||||||||
| Schulze et al. [36] | 2016 | Germany | 59 y, F | Steroids for suspected IBD | N/A | Liposomal amphotericin B/posaconazole/steroids | Colon, liver, LN, lung path/blood Cx | Survived |
|
| ||||||||
| Gómez-Espejo et al. [37] | 2017 | Venezuela | 23 y, M | HIV | 7 | Liposomal amphotericin B/dexamethasone/IVIG | Liver Bx | Survived |
|
| ||||||||
| Karthik Bommanan et al. [38] | 2017 | India | 32 y, M | Healthy | N/A | Amphotericin B | BM Bx path | Survived |
|
| ||||||||
| Souto Filho et al. [39] | 2017 | Brazil | 40 y, F | SLE | N/A | Amphotericin B/steroids | BM Bx path | Died (within 48 hrs) |
|
| ||||||||
| Ocon et al. [40] | 2017 | Guyana | 49 y, M | HIV | 7 | Liposomal amphotericin B/ART/IVIG/anakinra | Blood cx | Survived |
|
| ||||||||
| Loganantharajet al. [41] | 2017 | Dominican Republic | 46 y, M | HIV | 54 | Liposomal amphotericin B | Urine Ag/LN bx | Survived |
|
| ||||||||
| Huapaya et al. [42] | 2017 | USA | 46 y, M | Kidney transplant | N/A | Amphotericin B | Urine and serum Ag/BAL cytology | Survived |
Abbreviations: y, year; M, male; F, female; HIV, human immunodeficiency virus; NR, not reported; BM, bone marrow; N/A, not applicable; BAL, bronchoalveolar lavage; ART, antiretroviral therapy; IVIG, intravenous immunoglobulin; d, days; wks, weeks; Cx, culture, Bx, biopsy; path, histopathology; CSF, cerebrospinal fluid; CLL, chronic lymphocytic leukemia, TB, tuberculosis; GI, gastrointestinal; PCR, polymerase chain reaction; HCV, hepatitis C virus; CKD, chronic kidney disease; Ag, antigen; LN, lymph node; MCTD, mixed connective tissue disease; HD, hospital day; IBD: inflammatory bowel disease.