Dual infection: disseminated histoplasmosis and peritoneal tuberculosis in a HIV-negative immunocompetent patient. A case report.

Histoplasmosis is a dimorphic fungal infection that classically causes pulmonary disease in immunocompetent hosts and disseminated disease in the immunosuppressed. Tuberculosis has protean manifestations that overlap with histoplasmosis, and global limitations in mycological diagnostics frequently lead to misdiagnosis. We present a case of dual infection with culture-confirmed disseminated histoplasmosis and peritoneal tuberculosis in a HIV-negative, clinically immunocompetent man, whose only recognised risk factor was type 2 diabetes mellitus. This patient presented to a hospital in the United Kingdom, a non-endemic country. We discuss the diagnostic and therapeutic challenges posed by overlapping clinical presentations, concurrent antifungal-antimycobacterial regimens, and their cumulative toxicity.