Central nervous system histoplasmosis in an immunocompetent 5-year-old patient: a case report

Case presentation: IL, 5 years old, female, weighing 28,5kg, previously healthy. Sought medical attention due to intense and progressive headache for a year, worsening in the previous 90 days, followed by vomiting. Cranial magnetic resonance showed an intraparenchymal lesion optic chiasm suggestive of inflammatory injury infection or cancer, raising hypothesis tuberculosis pathway glioma. Cerebrospinal fluid analysis was negative tumor cells Mycobacterium tuberculosis. Tuberculin tests screening HIV, hepatitis, cytomegalovirus, syphilis were non-reactive. During hospitalization, presented with seizure, persistent hyporesponsiveness, Glasgow Coma Scale (GCS) 9. New neuroimaging increase number lesions diffusely both hemispheres meninges. In third month patient evolved complications, such as new seizures, repetitive respiratory infections, decrease neurological state, GCS 6–7. A biopsy cerebral tissue presence Histoplasma capsulatum, giving diagnosis central nervous system histoplasmosis (CNS). Treatment amphotericin B itraconazole established, without improvement. The latest severe sequelae, granulomatous disease, ischemia, gliosis/encephalomalacia. As stable, she released ambulatory treatment year. family agreed prioritize comfort above invasive measures, which would not bring benefits patient.