Histoplasmosis - More common than we realize.

Histoplasmosis is primarily associated with immunocompromised individuals; however, its presentation in immunocompetent patients is increasingly recognized. This series of 5 cases from eastern India, a potential Histoplasmosis hotspot, describes five immunocompetent individuals with the disease. It emphasizes the diverse clinical spectrum of Histoplasmosis, often mimicking other conditions, thereby complicating diagnosis. Four patients presented with adrenal masses, emphasizing the importance of considering histoplasmosis in the differential diagnosis of adrenal enlargement. One patient developed hemophagocytic lymphohistiocytosis (HLH), underscoring the severe complications associated with disseminated histoplasmosis. Additionally, one patient exhibited localized disease, demonstrating the variable clinical presentations of this infection. Our findings emphasize the need for heightened clinical suspicion of histoplasmosis in patients with adrenal masses or unexplained fever, even in immunocompetent individuals in a relevant epidemiological setting. Early diagnosis and appropriate antifungal therapy are crucial for optimal outcomes.