A 22-year-old man originally from Kara, Togo and now residing in Morocco, was diagnosed last year with disseminated African histoplasmosis, a rare fungal infection caused by Histoplasma capsulatum, according to health magazine Cureus. Histoplasmosis is not endemic in Morocco.
The patient had not traveled to his home country in three years when he presented at a Moroccan hospital with symptoms including a diffuse rash, hip pain, and an enlarged liver and spleen. The symptoms eventually pointed to histoplasmosis, a disease primarily endemic to regions such as Togo.
Upon admission to hospital, the patient exhibited multiple firm papules (small bumps in the skin), some with central depressions, scattered across his body. He also reported severe pain in his right hip and had signs of hepatosplenomegaly. Despite his immunocompetent status, laboratory and imaging tests revealed bone and organ involvement consistent with disseminated disease.
A skin biopsy confirmed the presence of Histoplasma capsulatum, and imaging studies identified significant joint and bone damage. The findings led to a diagnosis of progressive disseminated histoplasmosis, likely due to the reactivation of a latent infection acquired during his time in Togo.
Doctors treated the patient with oral itraconazole, a standard antifungal medication, at a dosage of 200 mg twice a day for 12 months. After one month of treatment, his skin lesions began to disappear, and subsequent imaging showed a reduction in hepatosplenomegaly. Follow-up over the course of a year revealed no recurrence of symptoms.
The case highlights the need for heightened awareness of rare infections such as histoplasmosis, particularly in non-endemic regions such as Morocco. While American histoplasmosis often affects the lungs, African histoplasmosis typically involves the skin and bones but can also lead to disseminated disease, as demonstrated in this case.
The patient’s history of frequent contact with bats in Togo, combined with his symptoms, turned out to be critical information in reaching an accurate diagnosis. However, the rarity of such cases in Morocco underscores the importance of considering travel history and endemic diseases when diagnosing patients presenting with unusual symptoms.
The case is a reminder of the global nature of health challenges and the necessity for healthcare providers to be on the lookout for diseases typically confined to specific regions.
The successful treatment of this rare condition in Morocco highlights the importance of early diagnosis and targeted therapy in managing complex infections.