LAUSR

On physical examination, he had hepatosplenomegaly, jaundice 3+/4+, dyspnea, SaPO2 93%, and whitish plaques on the tongue. Complementary tests revealed upper gastrointestinal bleeding on endoscopy; interstitial infiltrate, lymph node enlargement, and bronchial thickening on chest radiography; and visceromegaly on abdominal ultrasound. The laboratory profile revealed severe anemia and thrombocytopenia and mild leukocytosis (hemoglobin 4.8 g/dL, hematocrit 30.1%, leukocytes 11,800/mm3, platelets 45,000/mm3), besides intracellular structures in neutrophils suggestive of Histoplasma capsulatum in the blood smear (Figure 1A and 1B). The biochemistry was suggestive of an active inflammatory process (CRP 1040.0 mg/dL, DHL 1166 U/L), CD4 23/mm3. Broad-spectrum antimicrobial chemoprophylaxis for opportunistic pathogens was initiated; however, the patient progressed to a serious general condition and died from acute respiratory failure and septic shock in the second week of hospitalization.