Disseminated histoplasmosis in a 17-year-old Nigerian male patient

Rationale: Disseminated histoplasmosis is the most severe form of histoplasmosis and often associated with fatal outcomes. Both pulmonary and disseminated forms mimics tuberculosis (TB) and may be misdiagnosed. Patient concerns: A 17-year-old male patient compliant with anti- tuberculosis therapy with complaints of fever, cough productive of thick yellowish sputum, fast breathing, abdominal pain, swelling and jaundice. HIV status was negative. Diagnosis: Disseminated histoplasmosis. Interventions: Antimicrobials including anti-TB therapy, ceftriaxone, gentamicin, azithromycin and ciprofloxacin. Outcomes: He was responding to anti-TB drugs until about 4 and a half months on treatment when he fell ill. Peripheral blood film done 2 days prior to his demise revealed florid yeast like organisms in monocytes with eccentric chromatin suggestive of Histoplasma capsulatum . Lessons: Histoplasmosis can both mimic and coexist with TB and so a high index of suspicion is needed for its diagnosis.