Histoplasmosis mimicking primary lung neoplasm

Abstract

SUMMARYA 70-year-old man, ex-smoker with a 3-pack-year smoking history, presented with a 5-week history of persistent cough. There were no positive findings on clinical examination. The patient's chest X-ray showed a nodular density in the right lung, initially thought to be malignant. After an extensive workup which included CT-guided lung biopsies, bronchoscopies, positron emission tomography scanning, among many other investigations, discussion at the respiratory multidisciplinary team meeting, and a right upper lobe lung resection, a diagnosis of histoplasmosis was performed. BACKGROUND

Histoplasmosis Diagnosed in Europe and Israel: A Case Report and Systematic Review of the Literature from 2005 to 2020

“…The first important message arising from the review is that only seven cases diagnosed in Europe (1%) [23,70,79,105,106,121,126] and one diagnosed in Israel [131] were not associated with any disclosed history of travel or residence in areas considered to be endemic for the disease and can, therefore, possibly be classified as autochthonous: four in Italy [23,79,105,126], two in Spain [70,106], and one in Ireland [121]. Italy has long been considered a country with endemic foci of histoplasmosis, and a number of autochthonous cases have been previously reported [7,8,[145][146][147][148].…”

“…Median latency was 14 days in the case of travellers (range 2-120) and 6.5 years (range 3-46) in the case of migrants or expatriates. Six cases were considered to be autochthonous (three in Italy and one each in Spain, Ireland, and Israel) [105,106,117,121,126,131]; the Spanish case involved a laboratory technician who accidentally inoculated himself while handling a sample containing H. capsulatum [106]. The geographical areas in which the imported cases were acquired were mainly Central and South America (64.5%), followed by Africa (26.3%).…”

“…Most of the immunocompetent patients had pulmonary histoplasmosis (60/83, 73.2%), which was associated with rheumatological manifestations (arthralgia and/or erythema nodosum) in 23.3% of cases (Table 6). There were eight cases (13.3%) of single or multiple nodular lung lesions mimicking neoplasia or severe sarcoidosis [95,97,107,[119][120][121]128,133], three cases of chronic cavitary histoplasmosis [101,102,127], and one patient with fibrosing mediastinitis [130]. Five patients (6.2%) presented with a picture of PDH [103,116,123,125,126], and two showed central nervous system involvement [103,134].…”