Chronic disseminated histoplasmosis in an apparently immuno-competent Belgian patient

A 77 year-old Belgian man was admitted for weight loss and elevated liver enzymes. He used to live in Central Africa until 1986 and denied any travel outside Belgium during the last decade. Physical examination was unremarkable except for a lip ulceration. Blood tests showed increases of liver enzymes and CEA. In the search of an abdominal cancer, CT showed a normal liver but enlarged surrenal glands, while colonoscopy disclosed multiple mucosal lesions. Colic and lip biopsies identified Histoplasma capsulatum var capsulatum. HIV serology was negative. Lymphocyte count was normal but lymphocyte function was depressed. The patient dramatically improved under oral treatment with Itraconazole 400mg daily for six months. This case indicates that chronic disseminated Histoplasmosis can reactivate in a healthy and apparently non-immunocompromised person living in Europe.