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To the Editor.—
The report of Walker et al describes the problems encountered in establishing the diagnosis of disseminated histoplasmosis antemortem in a patient with symptoms compatible with the diagnosis of sarcoidosis.Histoplasmosis was considered in the differential diagnosis of this patient, as evidenced by performance of the histoplasmin skin test (which was positive) and a histoplasmin latex agglutination serological test (which was positive but no titer given). That the laboratory held the blood cultures for more than five weeks is further evidence that histoplasmosis was considered. The authors state that "serologic studies and prolonged followup excluded tuberculosis and fungal disease as the cause." Although additional studies may have provided a diagnosis, the outcome for this patient may not have been altered since he already had renal failure, and the renal toxicity of amphotericin B is well known.The latex agglutination titer rises early in an infection with Histoplasma capsulatum
DiSalvo AF. Histoplasmosis vs Sarcoidosis. JAMA. 1977;238(4):304-305. doi:10.1001/jama.1977.03280040024007