Disseminated Histoplasmosis: A Cause of Hemophagocytic Syndrome

From the Division of Hematology (Y.L), and the Department of Internal Medicine (L.T.H.), Mayo Clinic, Rochester, MN. A 41-year-old man was admitted to the hospital for evaluation of fevers, rigors, and general malaise of 3 weeks’ duration. His history was remarkable for chronic asthma treated with prednisone. Examination showed an ill-appearing man without localized findings. Fevers persisted despite broad-spectrum antibiotics. Laboratory findings included anemia (9.1 g/dL), leukopenia (2.4 10/L), thrombocytopenia (72 10/L), abnormal liver function (AST 377 U/L), and hyperferritinemia (37,630 mcg/L). Bone marrow aspirate demonstrated clusters of macrophages containing engulfed