Chronic progressive CNS histoplasmosis presenting in childhood: response to fluconazole therapy.

An 18-year-old Hispanic female developed symptoms of a Histoplasma capsulatum infection at 9 1/2 years of age. Initial problems of ataxia and hydrocephalus were followed by seizures and a cranial nerve palsy which developed over several years. T1-weighted cranial magnetic resonance imaging studies revealed numerous high-signal lesions; subsequently, signs of multisystem dissemination developed. Treatment included ventriculoperitoneal shunting, corticosteroids, amphotericin B, and a new antifungal agent, fluconazole, which was responsible for marked improvement.