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December 1985

Ketoconazole Therapy for AIDS Patients With Disseminated Histoplasmosis

Arch Intern Med. 1985;145(12):2272. doi:10.1001/archinte.1985.00360120144045

To the Editor.  —Bonner et al1 recently reported on disseminated histoplasmosis in three patients with the acquired immunodeficiency syndrome (AIDS). In the accompanying editorial, Wheat and Small2 suggested that ketoconazole suppressive therapy following initial treatment with amphotericin B should be the treatment of choice in AIDS patients with disseminated histoplasmosis. We report on our experience in treating disseminated histoplasmosis with maintenance ketoconazole following initial treatment with amphotericin B and ketoconazole.

Report of a Case.  —A 33-year-old man presented in the spring of 1983 with symptoms of weight loss, fever, generalized lymphadenopathy, and hepatosplenomegaly. The T-cell markers showed an inverted hepatosplenomegaly ratio (0.14) with lymphocyte depletion (10%). Cutaneous anergy was demonstrated to six recall antigens. He was followed up clinically without evidence of a major opportunistic infection or neoplasm until the summer of 1984, when he developed diffuse pulmonary infiltrates. Bronchoscopic biopsy specimens revealed histoplasmosis. Histoplasma capsulatum grew from

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