looking for definitive test

[aubrey07]

In 2004 I had a positive biopsy for Histoplasmosis. The doctor said my body would fight it. I have felt this nagging pain in my back ever since and sick with malaize and unexplainable symtoms,HOWEVER in December of 06 I came down with an infection in my chest wall. I went from z-packs, Biaxin, 3doses of Avelox and breathing treatments. I live in Tennessee, I moved from Indiana in 2002. I lost 20 lbs in March alone and have had continuous chest wall infections. Doctors seem reluctant to talk about Histoplasmosis. I am also getting sores on arms ,back, legs and head. I have had a negative urine antigen for Histoplasmosis. I also have a mass on my left adrenal as well as left lower lung lobe. I am a very sick person with no answers. I went to a new doctor thata friend suggested and was put on VANCOMYCIN AND ORAL SUSPENSION Of Ampho-b for a month. I was taken off that and put on Ketokonazole and after 2 wks of that I felt like a new person. All symtoms went away and I had energy, I got a call that my liver enzymes were up and to stop Ketokonazole. I understand the hepatotoxicity, but I finally responded to a medicine. Can someone tell me what tests to ask for so I may get a definitive answer towards what is happening. Would a PET scan help?

[National Jewish]

The very first step should be to either confirm or exclude the diagnosis of disseminated Histoplasmosis.  This would be done by culture and/or biopsy, as was done in 2004.  This could be done by examination of skin lesions including the chest wall infection and or lung biopsy of the left lower lobe mass.  The finding of Histoplasma antigen in the urine is strongly suggestive of the diagnosis and occurs in >90% of individuals with disseminated disease.

It must then be determined if treatment of Histoplasmosis is warranted, under any circumstance.  If treatment were indicated, the treatment would be with either Amphotericin or one of the 3 to 4 drugs that end in conazole, including itraconazole, all of which unfortunately are liver toxic.  At that time it would be helpful to know if your liver malfunction is due to the disease you have in your skin, chest wall and lung or due to itraconazole toxicity.  A PET scan would NOT be helpful.

Dissemination of Histoplasma, and some other fungi, most commonly occurs in individuals whose immune system is compromised.  Immunodeficiency can be acquired or inherited and there are many types, in addition to AIDS.  If you are found to be immunodeficient, determination of the type of immunodeficiency would be important, as a number of these conditions are treatable and, with treatment, your body would be better able to resist infection, Histoplasma or other.

Finally, you should have a candid discussion with your physician about your condition and what treatment options are available.

Good luck.