Histoplasmosis occurs predominantly in immunocompromised hosts and typically presents with mild constitutional symptoms, weight loss, weakness, fatigability, hepatosplenomegaly, and lymphadenopathy. The diagnosis is generally delayed and is based upon isolating the organism in blood cultures or by identifying intracellular organisms in tissues. Disseminated Histoplasmosis is well described in HIV patients but Histoplasmosis myositis is a rare manifestation and has not been reported in seronegative patients till date. We here address a case of a pharmacologically immunosuppressed patient with extensive Histoplasmosis myositis invading almost all the skeletal muscles of body (including plantar foot muscles) with no evidence of dissemination to other organ-systems. Clinical examination and investigations co-related with infiltrative muscle disease and skeletal muscle biopsy revealed Histoplasma capsulatum. This patient illustrates a distinctive clinical presentation of fungal infection with subtle constitutional symptoms and isolated muscle weakness which added to the diagnostic challenge. Hence, differential diagnosis of fungal infection must always be considered as a cause of myopathy in any pharmacologically immunosuppressed patient.


中文翻译：

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未消解的组织胞浆菌性肌炎：传播困难，诊断困难


组织胞浆菌病主要发生在免疫功能低下的宿主中，通常表现为轻度的体质症状，体重减轻，虚弱，易疲劳，肝脾肿大和淋巴结肿大。诊断通常会延迟，并且要基于在血液培养物中分离生物体或通过识别组织中的细胞内生物体。HIV病人中传播性组织胞浆菌病已有很好的描述，但组织胞浆菌病性肌炎是一种罕见的表现，血清阴性患者迄今尚未见报道。我们在这里处理的是一例药理学上受免疫抑制的患者，患有广泛的组织胞浆菌性肌炎，侵犯了人体的几乎所有骨骼肌（包括足底肌肉），而没有证据表明会扩散到其他器官系统。荚膜组织胞浆菌。该患者说明了真菌感染的独特临床表现，包括细微的体质症状和孤立的肌肉无力，这增加了诊断的难度。因此，在任何药理免疫抑制的患者中，必须始终将真菌感染的鉴别诊断视为肌病的病因。