<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0375-0760</journal-id>
<journal-title><![CDATA[Revista Cubana de Medicina Tropical]]></journal-title>
<abbrev-journal-title><![CDATA[Rev Cubana Med Trop]]></abbrev-journal-title>
<issn>0375-0760</issn>
<publisher>
<publisher-name><![CDATA[Centro Nacional de Información de Ciencias Médicas]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0375-07602020000300015</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Histoplasmosis diseminada asociada a síndrome de reconstitución inmune en un paciente con virus de la inmunodeficiencia humana]]></article-title>
<article-title xml:lang="en"><![CDATA[Disseminated histoplasmosis associated to immune reconstitution syndrome in a patient with human immunodeficiency virus]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Marulanda Nieto]]></surname>
<given-names><![CDATA[Christian Javier]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gartner López]]></surname>
<given-names><![CDATA[Estefanía]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Díaz Goméz]]></surname>
<given-names><![CDATA[Claudia Juliana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Aguilar Molina]]></surname>
<given-names><![CDATA[Oswaldo Enrique]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad del Valle Hospital Universitario del Valle Evaristo García E.S.E]]></institution>
<addr-line><![CDATA[Santiago de Cali ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad del Valle  ]]></institution>
<addr-line><![CDATA[Santiago de Cali ]]></addr-line>
<country>Colombia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2020</year>
</pub-date>
<volume>72</volume>
<numero>3</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_arttext&amp;pid=S0375-07602020000300015&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_abstract&amp;pid=S0375-07602020000300015&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.sld.cu/scielo.php?script=sci_pdf&amp;pid=S0375-07602020000300015&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Introducción: La histoplasmosis es una micosis profunda o sistémica causada por un hongo dimórfico que se puede diseminar principalmente en pacientes con inmunosupresión, como los que tienen diagnóstico de virus de la inmunodeficiencia humana. El síndrome de reconstitución inmune consiste en un empeoramiento paradójico de una condición conocida o de nueva aparición después del inicio de la terapia antirretroviral.  Objetivo: Describir un caso de histoplasmosis diseminada asociada a síndrome de reconstitución inmune en un paciente con infección por virus de la inmunodeficiencia humana.  Caso clínico: Paciente masculino de 32 años con diagnóstico de infección por virus de la inmunodeficiencia humana, con cuadro clínico de tres semanas de evolución. Este cuadro inició posterior al comienzo de la terapia antirretroviral, que consistió en pápulo-nódulos umbilicados diseminados, con compromiso pulmonar; además, tenía histopatología y cultivo positivos para Histoplasma capsulatum sl. y prueba de antigenuria para histoplasma también positiva. Se consideró un diagnóstico de histoplasmosis diseminada con presentación cutánea, fue la expresión de un síndrome de reconstitución inmune por desenmascaramiento. Se inició manejo con anfotericina B liposomal y se mantuvo la terapia antirretroviral; posteriormente se continuó el tratamiento con itraconazol durante 12 meses con mejoría de las lesiones.  Conclusiones: El diagnóstico clínico, histopatológico y microbiológico fue oportuno; el paciente presentó una adecuada respuesta al tratamiento. Esta es una micosis curable e incluso prevenible, si se diagnostica a tiempo, se inicia tratamiento precoz y se mantiene la terapia retroviral.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Introduction: Histoplasmosis is a deep or systemic mycosis caused by a dimorphic fungus which may disseminate mainly in immunocompromised patients, such as those diagnosed with human immunodeficiency virus. Immune reconstitution syndrome is a paradoxical worsening of a known condition or a condition appearing after the start of antiretroviral therapy.  Objective: Describe a case of disseminated histoplasmosis associated to immune reconstitution syndrome in a patient with human immunodeficiency virus infection.  Case report: A case is presented of a male 32-year-old patient diagnosed with human immunodeficiency virus with a clinical status of three weeks' evolution. The current status developed after the start of antiretroviral therapy. It consisted in disseminated umbilicated papular nodules with pulmonary involvement, as well as positive Histoplasma capsulatum sl. histopathology and culture, and a positive histoplasma antigen test. A diagnosis of disseminated histoplasmosis with a cutaneous presentation was considered. It was the expression of immune reconstitution syndrome by unmasking. Treatment was started with liposomal amphotericin B, maintaining the antiretroviral therapy. Management was then continued with itraconazole for 12 months with improvement of the lesions.  Conclusions: Timely clinical, histopathological and microbiological diagnosis was performed. The patient displayed an adequate response to treatment. This mycosis is curable and even preventable when a diagnosis is made in time, treatment is started early and the retroviral therapy is maintained.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[síndrome de reconstitución inmune]]></kwd>
<kwd lng="es"><![CDATA[micosis]]></kwd>
<kwd lng="es"><![CDATA[enfermedades cutáneas]]></kwd>
<kwd lng="es"><![CDATA[histoplasmosis]]></kwd>
<kwd lng="en"><![CDATA[immune reconstitution syndrome]]></kwd>
<kwd lng="en"><![CDATA[mycosis]]></kwd>
<kwd lng="en"><![CDATA[cutaneous conditions]]></kwd>
<kwd lng="en"><![CDATA[histoplasmosis]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sepúlveda]]></surname>
<given-names><![CDATA[VE]]></given-names>
</name>
<name>
<surname><![CDATA[Márquez]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Turissini]]></surname>
<given-names><![CDATA[DA]]></given-names>
</name>
<name>
<surname><![CDATA[Goldman]]></surname>
<given-names><![CDATA[WE]]></given-names>
</name>
<name>
<surname><![CDATA[Matute]]></surname>
<given-names><![CDATA[DR]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Genome sequences reveal cryptic speciation in the human pathogen Histoplasma capsulatum]]></article-title>
<source><![CDATA[Mbio]]></source>
<year>2017</year>
<volume>8</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>e01339-17</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mittal]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Ponce]]></surname>
<given-names><![CDATA[MG]]></given-names>
</name>
<name>
<surname><![CDATA[Gendlina]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Nosanchuk]]></surname>
<given-names><![CDATA[JD]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Histoplasma Capsulatum Mechanisms for Pathogenesis]]></article-title>
<source><![CDATA[Curr Top Microbiol Immunol]]></source>
<year>2019</year>
<volume>422</volume>
<page-range>157-91</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wheat]]></surname>
<given-names><![CDATA[LJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Histoplasmosis a review for clinicians from non-endemic areas]]></article-title>
<source><![CDATA[Mycoses]]></source>
<year>2006</year>
<volume>49</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>274-82</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wheat]]></surname>
<given-names><![CDATA[LJ]]></given-names>
</name>
<name>
<surname><![CDATA[Freifeld]]></surname>
<given-names><![CDATA[AG]]></given-names>
</name>
<name>
<surname><![CDATA[Kleiman]]></surname>
<given-names><![CDATA[MB]]></given-names>
</name>
<name>
<surname><![CDATA[Kleiman]]></surname>
<given-names><![CDATA[MB]]></given-names>
</name>
<name>
<surname><![CDATA[Baddley]]></surname>
<given-names><![CDATA[JW]]></given-names>
</name>
<name>
<surname><![CDATA[McKinsey]]></surname>
<given-names><![CDATA[DS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Clinical practice guidelines for the management of patients with histoplasmosis 2007 update by the Infectious Diseases Society of America]]></article-title>
<source><![CDATA[Clin Infect Dis]]></source>
<year>2007</year>
<volume>45</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>807-25</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Caceres]]></surname>
<given-names><![CDATA[DH]]></given-names>
</name>
<name>
<surname><![CDATA[Knuth]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Derado]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Lindsley]]></surname>
<given-names><![CDATA[MD]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Diagnosis of Progressive Disseminated Histoplasmosis in Advanced HIV: A Meta-Analysis of Assay Analytical Performance]]></article-title>
<source><![CDATA[J Fungi]]></source>
<year>2019</year>
<volume>18</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>76-89</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Deepe]]></surname>
<given-names><![CDATA[GS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Histoplasma capsulatum (histoplasmosis)]]></article-title>
<person-group person-group-type="editor">
<name>
<surname><![CDATA[Bennett]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
<name>
<surname><![CDATA[Dolin]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Blaser]]></surname>
<given-names><![CDATA[MJ]]></given-names>
</name>
<name>
<surname><![CDATA[Mandell]]></surname>
<given-names><![CDATA[GL]]></given-names>
</name>
<name>
<surname><![CDATA[Douglas]]></surname>
<given-names><![CDATA[Mandel]]></given-names>
</name>
</person-group>
<collab>Bennett&amp;apos</collab>
<source><![CDATA[sPrinciples and Practice of Infectious Diseases]]></source>
<year>2015</year>
<edition>8a</edition>
<page-range>2949-62</page-range><publisher-loc><![CDATA[Ámsterdam ]]></publisher-loc>
<publisher-name><![CDATA[Elsevier]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wheat]]></surname>
<given-names><![CDATA[LJ]]></given-names>
</name>
<name>
<surname><![CDATA[Azar]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
<name>
<surname><![CDATA[Bahr]]></surname>
<given-names><![CDATA[NC]]></given-names>
</name>
<name>
<surname><![CDATA[Spec]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Relich]]></surname>
<given-names><![CDATA[RF]]></given-names>
</name>
<name>
<surname><![CDATA[Hage]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Histoplasmosis]]></article-title>
<source><![CDATA[Infect Dis Clin North Am]]></source>
<year>2016</year>
<volume>30</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>207-27</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Delfino]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[di Biagio]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Chandrapatham]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Viscoli]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Prinapori]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Disseminated histoplasmosis with mucocutaneous immune reconstitution inflammatory syndrome in an HIV-infected patient]]></article-title>
<source><![CDATA[AIDS Res Hum Retroviruses]]></source>
<year>2015</year>
<volume>31</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>274-5</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Chang]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Rodas]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Skin lesions in histoplasmosis]]></article-title>
<source><![CDATA[Clin Dermatol]]></source>
<year>2012</year>
<volume>30</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>592-8</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nacher]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Sarazin]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[El Guedj]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Vaz]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Alvarez]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Nasser]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Randrianjohany]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Increased incidence of disseminated histoplasmosis following highly active antiretroviral therapy initiation]]></article-title>
<source><![CDATA[J Acquir Immune Defic Syndr]]></source>
<year>2006</year>
<volume>41</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>468-70</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dellière]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Guery]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Candon]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Rammaert]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Aguilar]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Lanternier]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Understanding Pathogenesis and Care Challenges of Immune Reconstitution Inflammatory Syndrome in Fungal Infections]]></article-title>
<source><![CDATA[J Fungi]]></source>
<year>2018</year>
<volume>4</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>139-61</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Manzardo]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Guardo]]></surname>
<given-names><![CDATA[AC]]></given-names>
</name>
<name>
<surname><![CDATA[Letang]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Plana]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Gatell]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Miro]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Opportunistic infections and immune reconstitution inflammatory syndrome in HIV-1-infected adults in the combined antiretroviral therapy era a comprehensive review]]></article-title>
<source><![CDATA[Expert Rev Anti Infect Ther]]></source>
<year>2015</year>
<volume>13</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>751-67</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kaplan]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
<name>
<surname><![CDATA[Benson]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Holmes]]></surname>
<given-names><![CDATA[KK]]></given-names>
</name>
<name>
<surname><![CDATA[Brooks]]></surname>
<given-names><![CDATA[JT]]></given-names>
</name>
<name>
<surname><![CDATA[Pau]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Masur]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America]]></article-title>
<source><![CDATA[MMWR Recomm Rep]]></source>
<year>2009</year>
<volume>58</volume>
<numero>RR-4</numero>
<issue>RR-4</issue>
<page-range>1-207</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
