Table 4.

Case reports of histoplasmosis in African children misdiagnosed as tuberculosis.

Sex/Age/Country	Clinical findings	HIV	Initial diagnosis	Diagnostic method/final diagnosis	Treatment/outcome	References
F/6/ Kenya	Fever, cough, abdominal pain. Examination findings: ill-looking, pale, wasted, febrile with bilateral pitting edema of the legs, hepatosplenomegaly, bilateral basal crepitations. Laboratory findings: Hb: 7.8 g/dL, ESR: 47 mm/1st hr. Sputum was negative for acid-fast bacilli (AFB), chest x-ray showed patchy pneumonic infiltrate.	P	Tuberculosis/leishmaniasis	Bone marrow aspirate cytology /DH	Not revealed	Pamnani et al. 11
M/14/ Nigeria	A painless lymph node swelling in the anterior neck region.	N	Tuberculosis lymphadenitis with a cold abscess/Lipoma	Biopsy of the lymph node swelling/African histoplasmosis	Not revealed	Khalil et al. 12
F/11/ South Africa	Weight loss, cough, and skin lesions. Examination findings: Pale, febrile, generalized lymphadenopathy and hepatosplenomegaly. Emaciated with hyperpigmented cutaneous plaques and nodules on her face, arms, and thighs. Hb = 91 g/L, WBC = 48 × 109/L, Platelet count = 94 × 109/L. Mantoux test: negative, sputum AFB: negative for acid-fast bacilli	P	Tuberculosis	Skin biopsy/DH (Hcc)	No improvement with anti-TB therapy IV AmB was commenced. She died a week later	Mosam et al. 13

AFB, acid-fast bacilli; AmB, amphotericin B; DH, disseminated histoplasmosis; N, negative; P, positive; TB, tuberculosis.