Disseminated histoplasmosis as a first clinical manifestation in a patient with small lymphocytic lymphoma: A case report
The small lymphocytic lymphoma is a mature B cell neoplasm with a broad spectrum of clinical presentations. Opportunistic infections that are not related to the treatment, even in advanced stages, have a low incidence rate. There are few case reports in the medical literature of patients who have not received immunosuppressive therapy and present with small lymphocytic lymphoma associated with disseminated histoplasmosis at diagnosis.
A female 82-year-old patient was admitted due to an intermittent dry cough, asthenia, and adynamia that had persisted for one month. Multiple studies to detect infections and immuno-rheumatic conditions were performed and an extensive cervical, thoracic and peritoneal adenopathic syndrome was diagnosed.
A flow cytometry and a cervical lymph node biopsy were performed reporting CD19+, CD20dim, CD5+, CD45+, CD23+, CD43neg, and CD10neg phenotypes with restriction in the light kappa chain compatible with a small lymphocytic lymphoma.
Epithelioid granulomas without necrosis were observed in the lymph node histopathology and special colorations showed no microorganisms. The culture from the lymph node was positive for Histoplasma capsulatum. We initiated treatment with amphotericin B and itraconazole with an adequate response. In the absence of compliance with oncology treatment criteria, the patient was managed on a “watch and wait” basis.
Opportunistic infections could be the initial clinical manifestation in patients with low-grade lymphoproliferative syndromes. This case report shows that they can develop even in the absence of chemotherapy.
['Silva|Nhora|N|', 'Calvache|Natalia|N|', 'Arrieta|Elizabeth|E|', 'Bravo|Juan Carlos|JC|', 'Salazar|Camilo|C|', 'Rosales|Joaquín|J|', 'Jaramillo|Francisco|F|', 'Restrepo|Juan Guillermo|JG|']
D000369:Aged, 80 and over D000544:Alzheimer Disease D000666:Amphotericin B D000935:Antifungal Agents D003924:Diabetes Mellitus, Type 2 D005260:Female D006658:Histoplasma D006660:Histoplasmosis D006801:Humans D006973:Hypertension D017964:Itraconazole D015451:Leukemia, Lymphocytic, Chronic, B-Cell D008198:Lymph Nodes D009894:Opportunistic Infections D057832:Watchful Waiting
histoplasmosis lymphocytic lymphoma case reports granuloma Histoplasma leukemia chronic, B-cell non- Hodgkin