Histoplasmosis-Associated Hemophagocytic Lymphohistiocytosis: A Review of the Literature

Table 4

Cases of histoplasmosis-associated histiocytic lymphohistiocytosis (HLH) in the literature.

Author	Year	Country	Age, gender	Underlying disease	CD4	Treatment	Histoplasma diagnosis	Outcome^∗
Majluf-Cruz et al. [5]	1993	Mexico	37 y, M	HIV	NR	Fluconazole	Liver Bx	Survived
			49 y, M	HIV	NR	Amphotericin B	BM Bx	Survived
			36 y, M	HIV	NR	None	BM Bx	Died (N/A)
Keller and Kurtzberg [6]	1994	USA	6 y	Chronic mucocutaneous candidiasis	N/A	Amphotericin B	BM Cx/blood Cx/BAL Cx	Survived
Koduri et al. [7]	1995	USA	NR	None	N/A	Amphotericin B/solumedrol	NR	Died (NR)
Koduri et al. [8]	1995	USA	NR	HIV	36	Amphotericin B/IVIG × 2d	Blood smear/BM path and Cx	Died (NR)
				HIV	4	Amphotericin B/IVIG × 2d	Blood smear/BM path/BM Cx/CSF Cx	Died (HD 6)
				HIV	6	Amphotericin B/IVIG × 2d	Blood smear/BM path and Cx	Died (NR)
				HIV	22	Amphotericin B/IVIG × 2d	BM path and Cx/skin Cx	Survived
				HIV	32	Amphotericin B	BM path and Cx	Survived
				HIV	44	Amphotericin B	BM path and Cx	Survived
Chemlal et al. [9]	1997	Africa	50 y	HIV	34	NR	Blood Cx/BM and skin path	NR
Kumar et al. [10]	2000	India	50 y, M	None	N/A	None	Splenic aspirate smears	Died (within 48 hours)
			40 y, M	HIV	NR	None	LN Bx	Died (within 48 hours)
Rao et al. [1]	2002	USA	68 y, M	CLL on cyclophosphamide and fludarabine	N/A	Amphotericin B	BM and lung Bx (path)	Survived
Masri et al. [11]	2003	USA	47 y, M	Heart transplant	N/A	Liposomal amphotericin B	BM (path and Cx)/peripheral smear/lung Bx (path and Cx)	Survived
Gil-Brusola et al. [12]	2007	Ecuador	33 y, M	HIV/disseminated TB	39	None	Blood smear/BM path	Died (HD 18)
Guiot et al. [13]	2007	Puerto Rico	43 y, M	HIV/ileal perforation	66	Liposomal amphotericin B for 21 days/itraconazole	GI (path)/BAL (cytology)/BM path and Cx, histoplasma PCR	Survived
Sanchez et al. [14]	2007	USA	61 y, M	HIV/pulmonary TB	4	Amphotericin B	Blood and BM (? Cx or path)	Survived
Wang et al. [15]	2007	USA	52 y, M	HCV, CKD	N/A	None (postmortem diagnosis)	Autopsy diagnosis/postmortem blood and spleen Cx	Died (HD 12)
Phillips et al. [16]	2008	USA	69 y, M	Sarcoidosis on chronic steroids	N/A	Amphotericin B/steroids/etoposide/cyclosporine	BM path and Cx/blood smear	Survived
De Lavaissiere et al. [17]	2009	France	33 y, M	HIV	NR	Amphotericin B/itraconazole/ART/IVIG	Blood and BM (Cx or path?)	Survived
Lo et al. [18]	2010	USA	22 y, F	Renal transplant	N/A	Liposomal amphotericin for 2 weeks/itraconazole	BM path/Blood Cx/urine Ag	Survived
		USA	18 y, M	Renal transplant	N/A	Liposomal amphotericin B for 1 week/itraconazole	LN path/BM Cx/urine Ag	Survived
van Koeveringe and Brouwer [19]	2010	Holland	50 y, M	CLL-alemtuzumab/fludarabine/cyclophosphamide	N/A	Dexamethasone/cyclosporine/etoposide/amphotericin B	BM path confirmed by PCR and culture	Survived
Vaid and Patel [20]	2011	UK	25 y, M	HIV	153	Antifungal	Skin/BM/oral mucosa path	Died (NR)
Chandra et al. [21]	2012	India	38 y, F	HIV	NR	Ketoconazole	NR	Survived
Nieto-Rios et al. [22]	2012	Colombia	30 y, F	Renal transplant	N/A	Amphotericin B/itraconazole	Blood Cx	Survived
			41 y, F	Renal transplant	N/A	None (died the same day of positive Cx)	Blood Cx	Died (HD 3)
Telfer and Gulati [23]	2012	USA	28 y, M	HIV	12	Voriconazole	BM path/urine Ag	Died (NR)
Huang [24]	2014	Guatemala	25 y, M	HIV	4	Antifungals/dexamethasone	Urine Ag/BM path	Survived
Subedee and van Sickels [25]	2015	USA	42 y, F	HIV	40	Liposomal amphotericin B/itraconazole	Urine Ag/BM path	Survived
Rajput et al. [26]	2015	Canada	64 y, F.	CKD, SCD	N/A	Antifungal therapy	BM and blood Cx	Survived
Kashifet al. [27]	2015	USA	34 y, M	SCD	N/A	Amphotericin B/itraconazole/dexamethasone/etoposide	LN Bx	Died (HD 8)
Castelliet al. [28]	2015	Mexico	32 y, M	HIV	3	Liposomal amphotericin B × 2 weeks/itraconazole/dexamethasone/etoposide	BAL Cx/Blood Cx/BM Cx	Survived
Mukherjee and Basu [29]	2015	India	52, M	COPD, Type II DM	N/A	Amphotericin B	Autopsy	Died (NR)
Townsend et al. [30]	2015	Mexico	31 y, F	HIV	1	Liposomal amphotericin B	Blood and BM Cx	Died (HD 16)
		USA	53 y, M	HIV	6	Liposomal amphotericin B × 14 d/itraconazole	Urine Ag	Survived
		USA	33 y, F	HIV	1	Liposomal amphotericin B × 21 d/fluconazole	Blood Cx/urine Ag	Survived
		Mexico	47 y, M	Immunosuppressive treatment		Itraconazole	Urine Ag	Survived
		USA	28 y, M	HIV	N/A	NR	Blood Cx/BM Cx/urine Ag	Survived
		USA	60 y, M	Immunosuppressive treatment	N/A	Liposomal amphotericin B/voriconazole/steroids/tacrolimus	BM path/skin Bx/urine Ag	Survived
		USA	44 y, M	HIV	2	Liposomal amphotericin B × 16 d/itraconazole	Sputum and blood Cx/urine Ag	Survived
		USA	52 y, M	HIV	16	Liposomal amphotericin B × 6 d/itraconazole/steroids/IVIG	BM Cx and urine Ag	Died (HD 9)
		USA	52 y, M	HIV	16	Liposomal amphotericin B × 3 d/itraconazole/IVIG	Blood Cx/BM path/urine Ag	Died (HD 9)
		El Salvador	32 y, M	HIV	50	Liposomal amphotericin B × 18 d/itraconazole	Blood, sputum, and BM Cx	Survived
		USA	51 y, M	HIV	9	Liposomal amphotericin B/steroids	Sputum, blood, gastric tissue Cx	Died (HD 13)
De and Nath [31]	2015	India	40 y, M	Healthy	N/A	Amphotericin B deoxy/itraconazole	BM Bx	Survived
			32 y, M	Healthy	N/A	Amphotericin B/itraconazole	BM Bx	Survived
Sonavane et al. [32]	2016	India	43 y, F	Healthy	N/A	Amphotericin B/itraconazole	BM Bx	Survived
Nieto et al. [33]	2016	Colombia	33 y, M	HIV	N/A	Amphotericin B/steroids	NR	Survived
Ferguson-Paulet al. [34]	2016	USA	6 months, F	MRSA bacteremia	N/A	Liposomal amphotericin B/itraconazole/etoposide/steroids	Urine serum Ag/BM and CSF Cx	Survived
Daoand He [35]	2016	USA	21 y, M	Crohn disease	N/A	Antifungal therapy	BM (cx and path)/Blood and BAL Cx	Survived
Schulze et al. [36]	2016	Germany	59 y, F	Steroids for suspected IBD	N/A	Liposomal amphotericin B/posaconazole/steroids	Colon, liver, LN, lung path/blood Cx	Survived
Gómez-Espejo et al. [37]	2017	Venezuela	23 y, M	HIV	7	Liposomal amphotericin B/dexamethasone/IVIG	Liver Bx	Survived
Karthik Bommanan et al. [38]	2017	India	32 y, M	Healthy	N/A	Amphotericin B	BM Bx path	Survived
Souto Filho et al. [39]	2017	Brazil	40 y, F	SLE	N/A	Amphotericin B/steroids	BM Bx path	Died (within 48 hrs)
Ocon et al. [40]	2017	Guyana	49 y, M	HIV	7	Liposomal amphotericin B/ART/IVIG/anakinra	Blood cx	Survived
Loganantharajet al. [41]	2017	Dominican Republic	46 y, M	HIV	54	Liposomal amphotericin B	Urine Ag/LN bx	Survived
Huapaya et al. [42]	2017	USA	46 y, M	Kidney transplant	N/A	Amphotericin B	Urine and serum Ag/BAL cytology	Survived

Abbreviations: y, year; M, male; F, female; HIV, human immunodeficiency virus; NR, not reported; BM, bone marrow; N/A, not applicable; BAL, bronchoalveolar lavage; ART, antiretroviral therapy; IVIG, intravenous immunoglobulin; d, days; wks, weeks; Cx, culture, Bx, biopsy; path, histopathology; CSF, cerebrospinal fluid; CLL, chronic lymphocytic leukemia, TB, tuberculosis; GI, gastrointestinal; PCR, polymerase chain reaction; HCV, hepatitis C virus; CKD, chronic kidney disease; Ag, antigen; LN, lymph node; MCTD, mixed connective tissue disease; HD, hospital day; IBD: inflammatory bowel disease.