Disseminated histoplasmosis diagnosed on a blood smear in a Nigerian patient with non-Hodgkin's lymphoma

Disseminated histoplasmosis is rarely reported in patients living with cancers in Nigeria. We report a 40-year-old woman who presented with left neck swelling and abdominal pain of two weeks duration. Clinical examination and radiological findings showed pallor, epigastric tenderness, generalized lymphadenopathy and hepatosplenomegaly. An initial diagnosis of sepsis and micronutrient deficiency was made following findings of macrocytosis, hypersegmented neutrophils and toxic granulations on blood smear. Intervention with antibiotics did not improve symptoms rather her clinical presentation worsened with the onset of fever, dizziness, easy fatiguability and generalized weakness. Histology of lymph node biopsy reported a diffuse large B-cell lymphoma. A repeat examination of the blood smear revealed budding yeast cells morphologically similar to Histoplasma capsulatum. This case emphasizes the need for a high index of suspicion of histoplasmosis in this at-risk population and the usefulness of a blood smear in diagnosing histoplasmosis.