Histoplasmosis with central nervous system involvement typically arises in the immunocompromised patient with disseminated fungal disease. Rarely, neurologic histoplasmosis may arise as an isolated syndrome in immunocompetent individuals without evidence of general dissemination. The disease often is diagnostically challenging, and a high index of suspicion is required for diagnosis. We describe an immunocompetent 13-year-old girl with atypical symptoms and unusual radiologic findings due to laboratory-confirmed histoplasma meningoencephalitis. She responded well to antifungal therapy.
GoodwinRA, JrShapiroJLThurmanGHThurmanSSDes PrezRM. Disseminated histoplasmosis: clinical and pathologic correlations. Medicine (Baltimore)1980;59:1–33.
2.
WheatLJKauffmanCA. Histoplasmosis. Infect Dis Clin North Am. 2003;17:1–19, vii.
3.
GeorgeRBPennRL. Histoplasmosis. In: SarosiGADaviesSF, eds. Fungal Diseases of the Lung. 2nd ed. New York: Raven Press; 1993:39–50.
4.
DeepeGSJrMcGuinnessM. Interleukin-1 and host control of pulmonary histoplasmosis. J Infect Dis. 2006;194:855–864.
5.
Wu-HsiehBA. Resistance mechanisms in murine experimental histoplasmosis. Arch Med Res. 1993;24:233–238.
6.
WheatLJBatteigerBESathapatayavongsB.Histoplasma capsulatum infections of the central nervous system. A clinical review. Medicine (Baltimore)1990;69:244–260.
7.
BergerJRGreenbergRN. Isolated central nervous system histoplasmosis in an immunocompetent patient: 53-month hiatus to diagnosis and treatment. J Neurovirol. 2010;16:472–474.
8.
RiveraIVCurlessRGIndacocheaFJScottGB. Chronic progressive CNS histoplasmosis presenting in childhood: response to fluconazole therapy. Pediatr Neurol. 1992;8:151–153.
9.
SchestatskyPChedidMFAmaralOBUnisGOliveiraFMSeveroLC. Isolated central nervous system histoplasmosis in immunocompetent hosts: a series of 11 cases. Scand J Infect Dis. 2006;38:43–48.
10.
WheatLJKohlerRBTewariRPGartenMFrenchML. Significance of Histoplasma antigen in the cerebrospinal fluid of patients with meningitis. Arch Intern Med. 1989;149:302–304.
11.
PlouffeJFFassRJ. Histoplasma meningitis: diagnostic value of cerebrospinal fluid serology. Ann Intern Med. 1980;92:189–191.
12.
ZalduondoFMProvenzaleJMHuletteCGoreckiJP. Meningitis, vasculitis, and cerebritis caused by CNS histoplasmosis: radiologic-pathologic correlation. AJR Am J Roentgenol. 1996;166:194–196.
13.
HamadaM, Tsuji S. [Central nervous system histoplasmosis]. Brain Nerve. 2009;61:129–134.
14.
Carod-ArtalFJVenturiniM, Gomes E, de Mello MT. [Chronic central nervous system histoplasmosis in an immunocompetent patient]. Neurologia. 2008;23:263–268.
