General symptoms:
(1) fever
(2) malaise
(3) anorexia
(4) weight loss
(5) night sweats
(6) pallor
Clinical findings:
(1) hepatosplenomegaly
(2) lymphadenopathy
(3) abdominal pain and tenderness, with or without diarrhea
(4) mucosal lesions (ulcerations, nodular tumors, verrucous lesions)
(5) skin lesions (ulcerations, nodular tumors, verrucous lesions)
(6) petechiae
Uncommon presentations:
(1) tendon, joint and/or bone involvement
(2) endocarditis
(3) meningitis or other CNS involvement
(4) genitourinary involvement
(5) sepsis syndrome with multi-organ failure
(6) hemophagocytic syndrome
(7) glomerulonephritis
(8) Addison's disease
Laboratory findings - acute phase reactants:
(1) elevated ESR
(2) elevated C-reactive protein (CRP)
(3) increased serum ferritin
Laboratory findings may include:
(1) elevated serum alkaline phosphatase
(2) hypercalcemia
(3) biochemical evidence of Addison's disease (adrenal insufficiency)
(4) pancytopenia
(5) elevated serum LDH
(6) yeast forms within bone marrow aspirate
(7) yeast forms within a tissue biopsy or aspirate
(8) rarely yeast forms within leukocytes in peripheral blood smears
(9) positive culture for Histoplasma capsulatum
Imaging findings:
(1) diffuse reticulonodular lesions in the lungs (may be absent)
(2) enlarged adrenal glands
(3) disseminated lesions or an abscess in the brain on MRI
Differential diagnosis:
(1) sarcoidosis
(2) tuberculosis
(3) malignant tumors
