HIV-associated disseminated histoplasmosis successfully treated with isavuconazole consolidation therapy

A 30-year-old man with advanced HIV and disseminated histoplasmosis deteriorated after stepping down from intravenous liposomal amphotericin B to itraconazole. Therapeutic levels of itraconazole and posaconazole were not achieved, therefore liposomal amphotericin B was reintroduced. Stepdown treatment was switched to oral isavuconazole; since then the patient has remained well. •Isavuconazole was effective in disseminated histoplasmosis as consolidation therapy.•Lower plasma isavuconazole levels (1.6–2 μg/mL) were associated with a good outcome.•With low plasma itraconazole levels, isavuconazole was a viable alternative.