Disseminated histoplasmosis in a patient from a nonendemic area who has acquired immunodeficiency syndrome.

Disseminated histoplasmosis is a serious opportunistic infection in patients with the acquired immunodeficiency syndrome (AIDS), often seen as the first manifestation of the syndrome. However, cases are reported almost exclusively from patients who live in or have traveled to endemic areas. We describe a case of disseminated histoplasmosis in a black woman with a 50-lb weight loss and marked weakness that occurred over a 6-month period. This case is one of the few in which disseminated histoplasmosis occurred as the first manifestation of AIDS in a patient in a nonendemic area. We believe it to be the first case reported in Michigan in which the patient has no history of prior residence in an endemic area. Disseminated histoplasmosis should be suspected in patients with AIDS and unexplained febrile illness, even in nonendemic areas.