Introduction:
Histoplasma capsulatum is rarely found in nose and sinuses in immunocompetent and even in immunosupressed patients. A literature review revealed rare cases of H. capsulatum sinusitis and the case we describe in this paper is the first case of H. capsulatum sinusitis in Morocco. The purpose of our work is to present a rare case of H. capsulatum sinusitis and a literature review.
Case report:
A male patient, at his 39 presented to the emergency with suffered from nasal congestion and yellow postnasal rhinorrhea, occasional headaches and epistaxis for over than two months. He had human immunodeficiency virus (HIV) infection for 6 years with failing treatment adherence and he had an opportunistic infection and unconfirmed pulmonary tuberculosis treated 3 years ago. Computerized tomography from paranasal sinus revealed complete opacification of the ethmoid-maxillary sinuses in the right fossa, consistent with acute sinusitis. The cultures of the sinus aspirate, skin biopsy, were positive for H. capsulatum and the histology of the nasal mucosa and skin biopsy specimen of the rash evoking a sinusitis and cutaneous histoplasmosis. The patient was started a treatment with intravenous amphotericin B at a rate of 1 mg/kg/day with clear clinical and biological improvement.
Discussion:
Cultures and histopathologic study confirm histoplasmosis. Itraconazole and amphotericin B are the first line drugs.
Conclusion:
Patients with progressive disseminated histoplasmosis and those with AIDS should be treated with amphotericin B, and the ENT should suspect of opportunistic agents in immunosupressed patients with sinusitis.