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What Does My Lab Test Report Indicate?

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Posted on Sat, 28 Oct 2017
Question: My Friend Male 49 yrs Old had Cutaneous Histoplasmosis ( with splenomegaly , No systemic involvement) in XXXXXXX 2010 , CD4- 214 ( 45%), Hiv RNA -negative, AntiDNA-4.0, ANA-1:80, TEE- No vegitation, It was cured and no recurrence there after , can it be HIV intiated infection or other disease , please confirm what test you recommended and what would be the recurrence chances and treatment recommended
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Answered by Dr. Dr. Kakkar (1 hour later)
Brief Answer:
Repeat HIV screening test

Detailed Answer:
Hello. thank you for writing to us.

I am Dr. Kakkar (Dermatologist). I have gone through your query and I have viewed the attachment.
Histoplasmosis is a deep fungal infection that is either limited to the lungs, or disseminates to skin as well as other organs (mostly immunodeficient individual) or is very rarely limited only to the skin.
From what I can see written in the discharge card the diagnosis was "Disseminated histoplasmosis" with splenomegaly. Disseminated histoplasmoss occurs in patients with some form of underlying immune deficiency e.g old age, underlying malignancy, HIV/ AIDS patients, organ transplanted patients, Lupus patients etc.
However, screening for HIV was non reactive, investigations for lupus were not unequivocal e.g ANA 1:80 and low level anti DNA antibodies, Bone marrow examination was normal, Serum Protein Electrophoresis was normal and PET scan was also normal.
The infection was cured with oral antifungals, his investigations did not reveal any other underlying immunodeficiency except a low CD4 T-cell count, however, the patient tested as HIV-ve at that time. Therefore it is highly unlikely that histoplasmosis would recur.
Perhaps he can do a repeat HIV screening in order to rule out any chances of the earlier test being falsely negative specially since the CD4+ T cell count was low at that time.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Dr. Kakkar

Dermatologist

Practicing since :2002

Answered : 9615 Questions

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What Does My Lab Test Report Indicate?

Brief Answer: Repeat HIV screening test Detailed Answer: Hello. thank you for writing to us. I am Dr. Kakkar (Dermatologist). I have gone through your query and I have viewed the attachment. Histoplasmosis is a deep fungal infection that is either limited to the lungs, or disseminates to skin as well as other organs (mostly immunodeficient individual) or is very rarely limited only to the skin. From what I can see written in the discharge card the diagnosis was "Disseminated histoplasmosis" with splenomegaly. Disseminated histoplasmoss occurs in patients with some form of underlying immune deficiency e.g old age, underlying malignancy, HIV/ AIDS patients, organ transplanted patients, Lupus patients etc. However, screening for HIV was non reactive, investigations for lupus were not unequivocal e.g ANA 1:80 and low level anti DNA antibodies, Bone marrow examination was normal, Serum Protein Electrophoresis was normal and PET scan was also normal. The infection was cured with oral antifungals, his investigations did not reveal any other underlying immunodeficiency except a low CD4 T-cell count, however, the patient tested as HIV-ve at that time. Therefore it is highly unlikely that histoplasmosis would recur. Perhaps he can do a repeat HIV screening in order to rule out any chances of the earlier test being falsely negative specially since the CD4+ T cell count was low at that time. Regards