My Hospital Journey With Histoplasmosis During Pregnancy.

I was consulted on a patient with disseminated histoplasmosis (affecting the lungs, liver, spleen, and bone marrow) when she was 20 weeks pregnant. In the hospital, she improved with amphotericin B but did not tolerate itraconazole. I scoured the literature to find the safest next steps for my patient and her unborn baby but was shocked at how little published information exists. We decided on amphotericin therapy via OPAT and switched to posaconazole after delivery. Her infant was asymptomatic but also treated with antifungals due to positive Histoplasma testing after birth. Our discussions, findings, and her clinical course prompted the adjoining review of histoplasmosis in pregnancy which is intended to help guide clinicians and patients if they face similar circumstances. I asked my patient if she wanted to contribute, and she wrote the following heartfelt essay. On paper, she and her baby did well, but that does not capture her harrowing journey and difficult decisions like her own words do.