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Histoplasma meningitis with common variable hypogammaglobulinemia.
Neurol Neurocir Psiquiatr. 1977; 18(2-3 Suppl):403-12.NN

Abstract

Histoplasma meningitis (HM) has been reported to occur primarily in association with disseminated histoplasmosis (DH). We report a case of histoplasma meningitis occurring in a patient with common variable hypogammaglobulinemia (CVH) in which no manifestations of DH were observed. L. L., a 66-year-old Caucasian male, clerical worker, developed occasional episodes of dizziness and tinnitus in mid-1971. During 1972, increasing frequency of these episodes and gradually progressive confusion were noted. In January 1973, vomiting, forther confusion, obnubilation, and a left central facial paresis developed and he was hospitalized. Physical examination revealed no pulmonary abnormalities, lymphadenopathy or hepatosplenomegaly. Over the ensuing 6-week evaluation, there was occasional fever to 38.5 degrees C. Chest roentgenogram was normal. Cerebral angiography suggested a mass in the left cerebellar hemisphere. EEG was diffusely slow. Multiple CSF examinations revealed: Glucose 7-18 mg/with a normal blood glucose, protein 109-256 mg/and cells 66-140 (95 + % mononuclear). Histoplasma capsulatum was cultured from CSF but not from sputum, urine, blood or bone marrow. Skin tests for PPD, histoplasmosis, coccidiodomycosis, blastomycosis, mumps, dinitrochlorobenzene and streptokinase-streptodornase were negative then and 6 months later. Histoplasma serum antibody was absent. Immunoglobulin analysis revealed IgG 430 mg %, IgA 46 mg %, and IgM 35 mg %, which with the history and skin test results suggested CVH. Treatment with 2.51 gm of amphotericin B given intravenously over a 3-month period resulted in complete reversal of all neurologic signs and clearing of the confusion. The remission has been maintained for two years. This case represents a primary infection of the CNS by histoplasma. The relationship between the HM and the CVH will be discussed.

Authors

No affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

616543

Citation

Couch, J R., and D A. Romyg. "Histoplasma Meningitis With Common Variable Hypogammaglobulinemia." Neurologia, Neurocirugia, Psiquiatria, vol. 18, no. 2-3 Suppl, 1977, pp. 403-12.
Couch JR, Romyg DA. Histoplasma meningitis with common variable hypogammaglobulinemia. Neurol Neurocir Psiquiatr. 1977;18(2-3 Suppl):403-12.
Couch, J. R., & Romyg, D. A. (1977). Histoplasma meningitis with common variable hypogammaglobulinemia. Neurologia, Neurocirugia, Psiquiatria, 18(2-3 Suppl), 403-12.
Couch JR, Romyg DA. Histoplasma Meningitis With Common Variable Hypogammaglobulinemia. Neurol Neurocir Psiquiatr. 1977;18(2-3 Suppl):403-12. PubMed PMID: 616543.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Histoplasma meningitis with common variable hypogammaglobulinemia. AU - Couch,J R, AU - Romyg,D A, PY - 1977/1/1/pubmed PY - 1977/1/1/medline PY - 1977/1/1/entrez SP - 403 EP - 12 JF - Neurologia, neurocirugia, psiquiatria JO - Neurol Neurocir Psiquiatr VL - 18 IS - 2-3 Suppl N2 - Histoplasma meningitis (HM) has been reported to occur primarily in association with disseminated histoplasmosis (DH). We report a case of histoplasma meningitis occurring in a patient with common variable hypogammaglobulinemia (CVH) in which no manifestations of DH were observed. L. L., a 66-year-old Caucasian male, clerical worker, developed occasional episodes of dizziness and tinnitus in mid-1971. During 1972, increasing frequency of these episodes and gradually progressive confusion were noted. In January 1973, vomiting, forther confusion, obnubilation, and a left central facial paresis developed and he was hospitalized. Physical examination revealed no pulmonary abnormalities, lymphadenopathy or hepatosplenomegaly. Over the ensuing 6-week evaluation, there was occasional fever to 38.5 degrees C. Chest roentgenogram was normal. Cerebral angiography suggested a mass in the left cerebellar hemisphere. EEG was diffusely slow. Multiple CSF examinations revealed: Glucose 7-18 mg/with a normal blood glucose, protein 109-256 mg/and cells 66-140 (95 + % mononuclear). Histoplasma capsulatum was cultured from CSF but not from sputum, urine, blood or bone marrow. Skin tests for PPD, histoplasmosis, coccidiodomycosis, blastomycosis, mumps, dinitrochlorobenzene and streptokinase-streptodornase were negative then and 6 months later. Histoplasma serum antibody was absent. Immunoglobulin analysis revealed IgG 430 mg %, IgA 46 mg %, and IgM 35 mg %, which with the history and skin test results suggested CVH. Treatment with 2.51 gm of amphotericin B given intravenously over a 3-month period resulted in complete reversal of all neurologic signs and clearing of the confusion. The remission has been maintained for two years. This case represents a primary infection of the CNS by histoplasma. The relationship between the HM and the CVH will be discussed. SN - 0028-3851 UR - https://www.unboundmedicine.com/medline/citation/616543/Histoplasma_meningitis_with_common_variable_hypogammaglobulinemia_ DB - PRIME DP - Unbound Medicine ER -