Vegetative Endocarditis Due to Histoplasma Capsulatum

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HISTOPLASMA capsulatum was first recognized by Darling1 in 1906 as being pathogenic for man. The organism most commonly causes a benign pulmonary infection which is not accompanied by symptoms and progresses to healing with calcification. Generalized infection occurs at times, however, and in these instances the fungus usually affects the reticuloendothelial system predominantly. Involvement of the heart is of rare occurrence, 9 cases having been reported to date.2,3,4,5,6,7,8,9,10 In 6 cases the pathologic lesions were those of an infective endocarditis, and in 2 the organisms were present only in the myocardium. In one the exact site of involvement was not mentioned. An additional case of vegetative endocarditis due to Histoplasma capsulatum is recorded in this report.

Report of Case

A white, married woman, 55 years of age, was admitted to the hospital on November 18, 1949 because of intermittent fever, a mildly productive cough, anorexia and weakness of 2 months’ duration. Periods of palpitation had been experienced for several months, but there had been no symptoms of myocardial failure. She had been receiving digitalis for 3½ weeks. There was a past history of rheumatic fever at the age of 8 years.

Physical examination revealed a poorly nourished patient in no acute distress. The temperature was 99 F., the heart rate 60 per minute, and the blood pressure 128 mm. systolic and 80 mm. diastolic. There were no petechiae, and no enlarged lymph glands were noted. The lungs were clear on percussion and auscultation. The area of relative cardiac dullness extended. . .



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