MILLING AROUND FOR A DIAGNOSIS IN A PATIENT WITH HIV AND MILIARY NODULES

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Histoplasmosis and Tuberculosis are two disease entities which may have similar presentations in the immunocompromised patient. Here we present a case of disseminated histoplasmosis patient with advanced HIV. CASE PRESENTATION: A 60-year-old male no known past medical history who presented fatigue, anorexia, dizziness, 25 pound weight loss over last 3 months. He is originally from Ethiopia, but he has been living Texas for more than 20 years. denied fever, chills, night sweats, chest pain, or cough. Vitals T100.5, P88, BP 127/62, RR 20, SpO2 100% on RA. Physical Exam was notable sarcopenia, clear lungs benign abdomen. Initial laboratories were Na 122, WBC 2.1, Hgb 11.4, platelets 71. Fourth generation HIV 1/2 screening positive, differentiation immunoassay positive HIV-1, CD4 count 14 cells/uL. CT-Chest demonstrated numerous bilateral pleural subpleural pulmonary nodules miliary pattern (Figure 1). x-ray showed innumerable diffuse nodular opacities 2). Bronchoscopy fluid AFB smear 1/3 cultures, TB-PCR negative culture to date. GMS stain bronchial specimens small intracellular fungal organisms, consistent histoplasmosis. Histoplasma urinary antigen above limit quantification. Patient treated Amphotericin B clinical improvement, including resolution fever hyponatremia. discharged oral itraconazole close follow-up initiate antiretroviral therapy. DISCUSSION: capsulatum dimorphic fungus endemic Ohio Mississippi river valleys, south-central United States, as well central south Africa. In patients (PWH), usually occurs those less 150 cells/Ul can be misdiagnosed tuberculosis (TB) (1). Among PWH, primary manifestations overall common TB (2), latter associated hepatosplenomegaly abdominal complaints. Specifically, distribution thoracic imaging reported Though dual infection rare without HIV, coinfection occur up 8-15% PWH (3), complicates diagnosis treatment. CONCLUSIONS: should included differential nodules, particularly areas States. evaluated given impact control REFERENCE #1: Evrard S, Caprasse P, Gavage Vasbien M, Radermacher J, Hayette MP, Sacheli R, Van Esbroeck Cnops L, Firre E, Médart Moerman F, Minon JM. Disseminated histoplasmosis: report review literature. Acta Clin Belg. 2018 Oct;73(5):356-363. doi: 10.1080/17843286.2017.1376454. Epub 2017 Sep 28. PMID: 28954600. #2: Adenis A, Nacher Hanf et al. among human immunodeficiency virus-infected patients: comparative study. Am J Trop Med Hyg. 2014;90(2):216-223. doi:10.4269/ajtmh.13-0084 #3: Agudelo CA, Restrepo Molina DA, Tobón AM, Kauffman Murillo C, A. co-infection AIDS patients. 2012 Dec;87(6):1094-8. 10.4269/ajtmh.2012.12-0292. Nov 5. 23128292; PMCID: PMC3516081. DISCLOSURES: No relevant relationships by Juan Deleija, source=Web Response Melanie Goebel, Jessica Kaczmarek,