Left atrial myxoma infected with histoplasma capsulatum

Rogers, Edwin W.; Weyman, Arthur E.; Noble, R. Joe; Bruins, S C

doi:10.1016/0002-9343(78)90591-0

Cited by 35 publications

(8 citation statements)

References 19 publications

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“… 11 , 23 To our knowledge, only 1 prior case caused by H. capsulatum has been reported. 25 In that patient, as in the patient reported here, both yeast and hyphal forms were noted in the myxomatous tissue. In the previously reported patient, who also had disseminated histoplasmosis, a bone marrow biopsy showed only small oval-shaped budding yeasts typical for H. capsulatum and no hyphal forms, in contrast to abundant hyphae seen in the myxoma and associated thrombus.…”

Section: Discussionsupporting

confidence: 70%

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Histoplasma capsulatum Endocarditis

et al. 2014

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Infective endocarditis is an uncommon manifestation of infection with Histoplasma capsulatum. The diagnosis is frequently missed, and outcomes historically have been poor. We present 14 cases of Histoplasma endocarditis seen in the last decade at medical centers throughout the United States. All patients were men, and 10 of the 14 had an infected prosthetic aortic valve. One patient had an infected left atrial myxoma. Symptoms were present a median of 7 weeks before the diagnosis was established. Blood cultures yielded H. capsulatum in only 6 (43%) patients. Histoplasma antigen was present in urine and/or serum in all but 3 of the patients and provided the first clue to the diagnosis of histoplasmosis for several patients. Antibody testing was positive for H. capsulatum in 6 of 8 patients in whom the test was performed.Eleven patients underwent surgery for valve replacement or myxoma removal. Large, friable vegetations were noted at surgery in most patients, confirming the preoperative transesophageal echocardiography findings. Histopathologic examination of valve tissue and the myxoma revealed granulomatous inflammation and large numbers of organisms in most specimens. Four of the excised valves and the atrial myxoma showed a mixture of both yeast and hyphal forms on histopathology.A lipid formulation of amphotericin B, administered for a median of 29 days, was the initial therapy in 11 of the 14 patients. This was followed by oral itraconazole therapy, in all but 2 patients. The length of itraconazole suppressive therapy ranged from 11 months to lifelong administration. Three patients (21%) died within 3 months of the date of diagnosis. All 3 deaths were in patients who had received either no or minimal (1 day and 1 week) amphotericin B.

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Section: Discussionsupporting

confidence: 70%

“…In the previously reported patient, who also had disseminated histoplasmosis, a bone marrow biopsy showed only small oval-shaped budding yeasts typical for H. capsulatum and no hyphal forms, in contrast to abundant hyphae seen in the myxoma and associated thrombus. 25 …”

Section: Discussionmentioning

confidence: 99%

Histoplasma capsulatum Endocarditis

et al. 2014

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“…Histoplasma endocarditis is a rare manifestation of disseminated histoplasmosis. Infection can occur on native valves, prosthetic valves, and even atrial myxomas (3,6,41,107). The patient has symptoms typical of chronic disseminated histoplasmosis and also has cardiac findings and embolic phenomena.…”

Section: Disseminated Histoplasmosismentioning

confidence: 99%

Histoplasmosis: a Clinical and Laboratory Update

2007

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SUMMARY Infection with Histoplasma capsulatum occurs commonly in areas in the Midwestern United States and Central America, but symptomatic disease requiring medical care is manifest in very few patients. The extent of disease depends on the number of conidia inhaled and the function of the host's cellular immune system. Pulmonary infection is the primary manifestation of histoplasmosis, varying from mild pneumonitis to severe acute respiratory distress syndrome. In those with emphysema, a chronic progressive form of histoplasmosis can ensue. Dissemination of H. capsulatum within macrophages is common and becomes symptomatic primarily in patients with defects in cellular immunity. The spectrum of disseminated infection includes acute, severe, life-threatening sepsis and chronic, slowly progressive infection. Diagnostic accuracy has improved greatly with the use of an assay for Histoplasma antigen in the urine; serology remains useful for certain forms of histoplasmosis, and culture is the ultimate confirming diagnostic test. Classically, histoplasmosis has been treated with long courses of amphotericin B. Today, amphotericin B is rarely used except for severe infection and then only for a few weeks, followed by azole therapy. Itraconazole is the azole of choice following initial amphotericin B treatment and for primary treatment of mild to moderate histoplasmosis.

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“…Embolization of an infected myxoma can lead to intracerebral ischemia, hemorrhage, lung or brain abscess, mitral or pulmonary valve endocarditis, and other downstream effects [ 5 ]. Diagnosis requires a myxoma documented by pathology with associated microorganisms on pathology or positive blood cultures [ 7 ]. Additionally, transesophageal echocardiogram has shown high diagnostic sensitivity approaching 100% [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

A Unique Case of a Right Atrial Myxoma Infected With Escherichia coli

Javeed¹,

Gruhonjic²,

Kirkman³

et al. 2022

Cureus

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A 70-year-old white male, with past medical history of coronary artery disease, peripheral arterial disease status-post bilateral femoral artery stents, insulin-dependent diabetes mellitus, hypertension, hyperlipidemia, arthritis, tobacco use, and alcohol use, presented with shortness of breath and an abnormal finding on a recent transesophageal echo. This had revealed a large, fixed mass in the right atrium. Our differential diagnosis had included thrombus, endocarditis, myxoma, papillary fibroelastoma, sarcoma, and metastatic tumor. The cardiothoracic surgeon excised this mass, which upon culturing, revealed what we found to be the only reported case of an atrial myxoma infected with Escherichia coli. In addition to surgical excision, the patient was treated with six weeks of intravenous cefepime.

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Left atrial myxoma infected with histoplasma capsulatum

Cited by 35 publications

References 19 publications

Histoplasma capsulatum Endocarditis

Histoplasma capsulatum Endocarditis

Histoplasmosis: a Clinical and Laboratory Update

A Unique Case of a Right Atrial Myxoma Infected With Escherichia coli

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