Hemophagocytic lymphohistiocytosis secondary to disseminated histoplasmosis diagnosed by bone marrow smear microscopy and metagenomic next-generation sequencing: A case report and review of literature.
Li Ma, Jinlin Zhang, Xiaoyuan He et al.
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Case in brief
An immunocompetent patient presented with disseminated histoplasmosis, leading to rapid clinical deterioration and a diagnosis of hemophagocytic lymphohistiocytosis (HLH). The infection was confirmed through bone marrow smear microscopy and metagenomic next-generation sequencing. The patient improved following targeted treatment with amphotericin B, etoposide, and ruxolitinib.
What made this case unusual
This case highlights the sequential morphological changes of Histoplasma capsulatum in bone marrow tissue, which is rarely described in the literature.
Diagnostic / clinical pearl
Clinicians should consider hemophagocytic lymphohistiocytosis in immunocompetent patients with atypical presentations of disseminated histoplasmosis, especially when conventional diagnostics are inconclusive.
Why it matters
The combination of bone marrow examination and metagenomic next-generation sequencing can provide early and definitive diagnosis of disseminated histoplasmosis, potentially improving patient outcomes.