Disseminated histoplasmosis is an opportunistic infection which is commonly associated with HIV. Haemophagocytic lymphohistiocytosis (HLH) has been described as a secondary phenomenon to infection, collagen-vascular disorders and malignancies. In patients with HIV, cases of reactive haemophagocytic syndrome associated with disseminated histoplasmosis have been reported with CD4 counts of less than 50 cells/µl (450-1660 cells/µl). We report a case of a 25 year old man with HIV who presented with a CD4 count of 153 cells/µl and would suggest that this diagnosis should be considered at higher CD4 counts than previously reported.
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