An Uncommon Presentation of Histoplasmosis in India: Pancytopenia and Massive Splenomegaly in an Immunocompetent Patient

Abstract Histoplasmosis is a systemic fungal infection caused by Histoplasma capsulatum . It typically remains asymptomatic in immunocompetent individuals but can progress to life-threatening disease in immunocompromised patients. Here, we present an interesting case involving a 52-year-old immunocompetent patient in India who presented with a high-grade fever, accompanied by chills, mild cough, and generalized weakness persisting for over a week. Further investigations revealed severe pancytopenia and massive splenomegaly. After excluding common infectious causes, a bone marrow aspiration was performed, revealing intra and extracellular small, oval yeast-like cells suggestive of histoplasmosis. These findings were confirmed by a positive urinary Histoplasma antigen test and a bone marrow biopsy showing uniform budding yeasts within histiocytes. Treatment was initiated with liposomal amphotericin B, the first-line therapy for histoplasmosis; however, the patient experienced nephrotoxicity with this drug. Subsequently, the patient was treated with long-term oral itraconazole therapy.