An Unusual Cause of Fever, Generalized Lymphadenopathy and Eosinophilia in a HCV-Positive 6-Year-Old Boy

A 6-year-old boy presented with a 3-month history of high-grade fever and night-sweats but without chills/rigors. On examination, he had moderate hepatosplenomegaly with multiple enlarged cervical and axillary lymph nodes. His hemogram revealed anemia and marked eosinophilia. Initial investigations were negative, except anti-HCV IgG antibodies, that were positive. Bone marrow aspirate showed a single histiocyte containing suspicious intracellular yeast-like forms. Cervical lymph node aspiration revealed a heavy load of intra- and extra-cellular Histoplasma spp. Disseminated histoplasmosis remains an unusual cause of peripheral eosinophilia and diagnosis can often be rendered fairly easily by cytomorphological evaluation. The case illustrates how Indian pathologists must maintain a high index of suspicion for unexpected infectious disorders in cases with eosinophilia.