Disseminated Histoplasmosis as a Presentation of Advanced HIV-1 Infection in a Non-endemic Country

Disseminated histoplasmosis is an opportunistic fungal infection considered an AIDS-defining illness, sometimes with a fatal outcome. We report a case of disseminated histoplasmosis as the initial presentation of advanced HIV-1 infection in a migrant living in a non-endemic area. Histoplasmosis was suspected based on the clinical presentation, epidemiological factors, and observation in the peripheral blood smear of neutrophils and monocytes with yeast-like forms. The diagnosis was confirmed through a positive peripheral blood smear and subsequent culture of <i>Histoplasma capsulatum</i> from a bronchoalveolar lavage sample. The patient was treated with 14 days of liposomal amphotericin B plus oral itraconazole for two years, with a good response. Direct examination of peripheral blood has been considered a valuable diagnostic method, specifically in severely immunocompromised patients, as our case report. The presented case highlights the importance of considering disseminated histoplasmosis in the differential diagnosis of HIV-infected patients, even in non-endemic regions. Hence, the need for a high index of suspicion to ensure early diagnosis and treatment is crucial as the influx of migrants increases globally.