Histoplasmose pulmonar cavitária crônica

Abstract

A 69-year-old female smoker (30 packyears) homemaker from São Sepe, Brazil, presented with rheumatoid arthritis for 14 years. The patient had undergone a thyroidectomy 20 years before. The epidemiological history was not clear regarding possible fungal exposure. The patient had been experiencing progressive dyspnea, productive cough, recurrent respiratory infections, loss of appetite, nausea and weight loss for 4 years. The patient was using levothyroxine, calcitriol and prednisone 15 mg/day; however, she had previously used methotrexate. Physical examination revealed that the patient had lost weight (patient weight at the time was 30 kg, and body mass index was 14 kg/m 2 ). No cervical lymph node enlargement, supraclavic- IntroductionHistoplasmosis is a systemic mycosis caused by the thermally dimorphic fungus Histoplasma capsulatum, which can be isolated from soil contaminated with droppings from birds or bats. (1,2) Similar to other systemic mycoses, the initial exposure is through inhalation, and pulmonary impairment is the predominant form of presentation of the disease. Large outbreaks of the disease have been reported; however, most of the infections are sporadic. (3) Chronic pulmonary histoplasmosis is a rare clinical manifestation of the disease that affects the upper lobes of the lungs and can present as cavitation and fibrosis. (4)(5)(6)(7) We report the case of a female patient with chronic cavitary pulmonary histoplasmosis (CCPH). AbstractHistoplasmosis is a systemic mycosis caused by the thermally dimorphic fungus Histoplasma capsulatum, which can be isolated from soil contaminated with droppings from birds or bats. Chronic cavitary pulmonary histoplasmosis is one of the rarest clinical presentations of this disease. The differential diagnosis with tuberculosis should be made in patients presenting with cavitated lesions in upper lung segments. We report the case of a female patient with chronic cavitary pulmonary histoplasmosis who had presented with progressive dyspnea and worsening of the radiological pattern over a four-year period.Keywords: Histoplasmosis; Cavitation; Pulmonary emphysema. ResumoA histoplasmose é uma micose sistêmica causada pelo fungo dimórfico térmico Histoplasma capsulatum, que pode ser isolado a partir de solo contaminado com excrementos de aves e morcegos. Dentre as apresentações clínicas dessa doença, a histoplasmose pulmonar cavitária crônica (HPCC) é uma manifestação rara. O diagnóstico diferencial com tuberculose deve ser realizado em pacientes que apresentam lesões cavitadas nos segmentos pulmonares superiores. É relatado um caso de uma paciente com HPCC que apresentou dispneia progressiva e piora do padrão radiológico em quatro anos de evolução da doença.

Un caso excepcional de paracoccidioidomicosis e histoplasmosis pulmonares de presentación concomitante

“…Mediastinal nodal involvement can lead to necrosis, (9) and this is due to paracoccidioidomycosis, given that chronic cavitary histoplasmosis does not usually cause mediastinal adenopathy. (10) In Uruguay, this is the first documented case of concomitant paracoccidioidomycosis and histoplasmosis, and we found no similar cases in hyperendemic areas. (11) The occupation and place of residence of our patient are of note because they are typically associated with paracoccidioidomycosis, which is due to the reservoir distribution analyzed previously.…”

“…Treatment duration correlates with the severity of the disease and the drug used, and it is recommended that it be maintained for six months to one year. (10) The patient must remain under treatment and follow-up until the criteria for cure are met, on the basis of clinical, imaging, and serological parameters. Although the lung lesions are irreversible and the loss of pulmonary function in subacute and chronic forms is usually irreversible, the clinical condition of the patient improved after prolonged antifungal treatment.…”

Fatal fulminant necrotizing pneumonia: a case report

“…Chronic pulmonary histoplasmosis can be associated with cavitary changes but is usually seen in older patients and in individuals with significant underlying parenchymal disease [4]. The chest CT in such patients typically demonstrates interstitial infiltrates, along with pre-existing changes of emphysema and foci of cavitation or destruction with thickened walls [10]. Our patient was relatively young.…”

Histoplasmose Pulmonar: Uma Revisão

“…A histoplasmose pulmonar é uma micose causada pelo fungo dimórfico Histoplasma capsulatum, sendo considerada como uma das infecções respiratórias fúngicas mais comum no mundo (YANG et al, 2013). Esta doença foi descrita pela primeira vez por Samuel Darling, no (OIKAWA et al, 2010;MARTINS et al, 2003 (YANG et al, 2013;NOSANCHUK et al, 2012 (KAUFFMAN, 2007;SANTOS et al, 2009). O aumento das bolhas e necrose pulmonar resulta na formação de cavidades persistentes.…”

“…O aumento das bolhas e necrose pulmonar resulta na formação de cavidades persistentes. Desse modo, ocorre uma perda de volume da parte superior dos lobos pulmonares (KAUFFMAN, 2007;DEEPE et al, 2008 (SANTOS et al, 2009;EGRESSY et al, 2015;RIHANA et al, 2014).…”