Rapidly fatal disseminated histoplasmosis presenting as acute respiratory distress syndrome in a patient with HIV

Patients with acquired immunodeficiency syndrome (AIDS) are susceptible to opportunistic infections like disseminated histoplasmosis (DH). Rarely, patients with DH can present with fatal complications as acute respiratory distress syndrome (ARDS) and multiorgan failure. This case adds some clinical and histopathological insights about the fatal course of this disease. A 41-years-old female with a medical history of AIDS and abandonment of antiretroviral therapy was admitted to the Intensive Care Unit (ICU) due to progressive dyspnea, severe ARDS and septic shock. The patient required invasive mechanical ventilation and 16 hours after admission the patient had a cardiac arrest. She was declared dead of undetermined cause, 16 hours after admission. Autopsy findings were consistent with DH, including fungal meningoencephalitis and fungal lesions in liver, spleen, pancreas and a bilateral diffuse alveolar hemorrhage. In critically-ill patients with AIDS and acute respiratory failure, DH should be an important differential diagnosis in endemic areas, as the symptoms are nonspecific and the patient can present a rapidly fatal evolution despite appropriate interventions. Autopsy findings can improve our knowledge about this rare and severe disease.