Rare Coexistence of Disseminated Histoplasmosis and Pigment Nephropathy in an Immunocompetent Patient

A BSTRACT This case report highlights the unusual concurrent occurrence of disseminated histoplasmosis and pigment nephropathy in a 38-year-old immunocompetent male. The patient presented with a 1-week history of fever, abdominal pain, generalized body aches, vomiting, and decreased urine output, which progressed to oliguric renal failure. Clinical and laboratory findings revealed significant renal impairment, while imaging studies noted bilateral adrenal gland enlargement. A renal biopsy showed acute tubular injury with pigmented casts, and an ultrasound-guided adrenal biopsy confirmed Histoplasma capsulatum infection. The patient was treated with IV antifungals, along with aggressive fluid resuscitation and alternate-day hemodialysis, resulting in renal function improvement and eventual dialysis independence within a week. This case underscores the necessity of a thorough clinical evaluation and early diagnosis in patients with atypical presentations of disseminated fungal infections, especially considering the potential for renal complications in immunocompetent individuals.