Progressive disseminated histoplasmosis in patients with the acquired immune deficiency syndrome: a report of 12 cases and a literature review.

Progressive disseminated histoplasmosis is an increasingly common cause of infection in patients with acquired immune deficiency syndrome (AIDS) from areas endemic for histoplasmosis. We report 12 cases of progressive disseminated histoplasmosis associated with AIDS and review 20 previously reported cases. The clinical presentation of progressive disseminated histoplasmosis is nonspecific with persistent fever, weight loss, and splenomegaly. Frequently progressive disseminated histoplasmosis was the initial clue to the presence of AIDS. Bone marrow culture is the best method for establishing a diagnosis. Relapses were common both with ketoconazole and after a 2.0 to 2.5 g course of amphotericin B. This suggests a 2.0 to 2.5 g course of amphotericin B followed by long term ketoconazole suppression may be the best therapeutic regimen in these patients.