Mediastinal histoplasmosis presenting as dysphagia: a case report with literature review

Abstract

Histoplasmosis is an endemic infection of the Ohio and Mississippi River valleys. Clinical presentation of infection in immunocompetent hosts ranges from asymptomatic to minor flu-like symptoms; however, disseminated infection can occur in immunocompromised patients. Esophageal involvement in the form of dysphagia secondary to mediastinal histoplasmosis is rarely reported in the literature. We present a young female who complained of dysphagia and was found to have an esophageal stricture on barium esophagogram. Endoscopy revealed a submucosal nodule stricture situated 29 cm from the incisors. She underwent thoracotomy for lymph node removal. Histologic findings of the removed lymph node showed caseating granuloma with macrophages. The clinical findings together with the laboratory evaluation and biopsy features were suggestive of mediastinal histoplasmosis as the cause of the dysphagia.

Gastrointestinal Histoplasmosis: A Descriptive Review, 2001–2021

“…Endoscopic findings in GIH involving the oesophagus could be erythema or local inflammation [ 40 , 42 , 56 , 58 , 105 ], polyps [ 13 ] and ulcerations [ 20 , 84 , 100 , 104 , 121 ]. During the period under review, twelve patients [ 13 , 20 , 40 , 42 , 48 , 56 , 58 , 84 , 100 , 104 , 105 , 121 ] presented with GIH with oesophageal involvement and five were immunocompromised [ 13 , 40 , 100 , 104 , 121 ] with HIV infection. Treatment with intravenous amphotericin B and itraconazole [ 13 , 40 , 42 , 48 , 56 , 58 , 84 , 104 , 105 , 121 ] resulted in a favourable outcome; one patient died due to dual opportunistic infection with tuberculosis [ 100 ] and the other died before treatment was commenced [ 20 ].…”

A Case of a Mediastinal Mass in a Teenager Causing Chest Pain, Difficulty Breathing, and Emesis: A Rare Complication of a Relatively Common Disease

“…13 Although gastrointestinal histoplasmosis can occur as a consequence of disseminated disease, esophageal involvement associated with impingement from mediastinal histoplasmosis lymphadenopathy is only reported in 5% to 13% of cases. 9 Here we present what we believe to be the second reported case of both esophageal and bronchial obstruction by mediastinal granuloma from pulmonary histoplasmosis in the past 2 decades.…”

“…Between 2000 and 2020, there were 8 reported cases of pulmonary histoplasmosis causing mediastinal granulomas in immunocompetent individuals, 5,7-13 one of which did not cause obstructive symptoms. 7 Of the 7 patients who developed compression from mediastinal granulomas, 1 patient presented with a pulmonary arterial mass, 8 2 patients with primarily esophageal involvement, 9,10 3 patients with primarily bronchial obstruction, 5,11,12 and 1 patient with both esophageal and bronchial obstruction. 13 Although gastrointestinal histoplasmosis can occur as a consequence of disseminated disease, esophageal involvement associated with impingement from mediastinal histoplasmosis lymphadenopathy is only reported in 5% to 13% of cases.…”

Histoplasmosis peritonitis in an immunocompetent patient: case report

“…All but one needed antifungal treatment. One patient required thoracotomy for oesophageal involvement secondary to mediastinal histoplasmosis [ 6 ]. In addition, we found only 4 other reported cases, which are summarized in Table 1 .…”