Miliary Histoplasmosis in a Patient with Rheumatoid Arthritis

Lum, Jessica; Abidi, Maheen Z.; McCollister, Bruce D.; Henao‐Martínez, Andrés F.

doi:10.1155/2018/2723489

Cited by 6 publications

(8 citation statements)

References 20 publications

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“…Occasionally, signs and symptoms of adrenal insufficiency such as dizziness, fatigue, and sweating due to hypotension and hypoglycemia are present. 38,42,44,64 Radiological and imaging features in the lung simulate tuberculosis to a great extent with the presence of mediastinal lymphadenopathy and bilateral lung lesions. The lung lesions show a mixed pattern with fibrosis, nodules, patchy consolidation, and cavitation all present together (►Fig.…”

Section: Histoplasmosismentioning

confidence: 99%

“…Co-existing adrenal involvement and mucocutaneous lesions are important indicators for the aetiology of Histoplasma infection and their simultaneous occurrence also affect the patient prognosis. 38,39,42,43,64 Differential diagnosis: The most frequently overlapping imaging diagnosis is tuberculosis, if the images are evaluated without due diligence. The radiological features that favor histoplasmosis are the absence of significant pleural effusion, presence of subpleural nodule/s, fibrosing mediastinitis, associated hepatosplenomegaly without focal lesions, and necrotic adrenomegaly.…”

Section: Histoplasmosismentioning

confidence: 99%

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Imaging Approach to Pulmonary Infections in the Immunocompromised Patient

Grover

Antil

et al. 2022

Indian J Radiol Imaging

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Pulmonary infections are the major cause of morbidity and mortality in immunocompromised patients and almost one-third of intensive care unit patients with pulmonary infections belong to the immunocompromised category. Multiple organisms may simultaneously infect an immunocompromised patient and the overwhelming burden of mixed infections further predisposes critically ill patients to acute hypoxemic respiratory failure. Notwithstanding that lung ultrasound is coming into vogue, the primary imaging investigation is a chest radiograph, followed by thoracic CT scan. This review based on our experience at tertiary care teaching hospitals provides insights into the spectrum of imaging features of various pulmonary infections occurring in immunocompromised patients. This review is unique as, firstly, the imaging spectrum described by us is categorized on basis of the etiological infective agent, comprehensively and emphatically correlated with the clinical setting of the patient. Secondly, a characteristic imaging pattern is emphasized in the clinical setting-imaging-pattern conglomerate, to highlight the most likely diagnosis possible in such a combination. Thirdly, the simulating conditions for a relevant differential diagnosis are discussed in each section. Fourthly, not only are the specific diagnostic and tissue sampling techniques for confirmation of the suspected etiological agent described, but the recommended pharmaco-therapeutic agents are also enumerated, so as to provide a more robust insight to the radiologist. Last but not the least, we summarize and conclude with a diagnostic algorithm, derived by us from the characteristic illustrative cases. The proposed algorithm, illustrated as a flowchart, emphasizes a diagnostic imaging approach comprising: correlation of the imaging pattern with clinical setting and with associated abnormalities in the thorax and in other organs/systems, which is comprehensively analyzed in arriving at the most likely diagnosis. Since a rapid evaluation and emergent management of such patients is of pressing concern not only to the radiologist, but also for the general physicians, pulmonologists, critical care specialists, oncologists and transplant surgery teams, we believe our review is very informative to a wide spectrum reader audience.

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Section: Histoplasmosismentioning

confidence: 99%

Section: Histoplasmosismentioning

confidence: 99%

Imaging Approach to Pulmonary Infections in the Immunocompromised Patient

Grover

Antil

et al. 2022

Indian J Radiol Imaging

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“…The production of tumor necrosis factor 'alpha' and interferon gamma activates macrophages with phagocytose of the organism inhibiting its growth. With the HIV pandemic and the increasing number of patients receiving immunosuppressive therapies, the population at risk for histoplasmosis will continue to grow [15,16,20].…”

Section: Etiology Epidemiology and Pathogenesismentioning

confidence: 99%

“…Cases of miliary histoplasmosis have been reported in the literature. This form of presentation mimic miliary tuberculosis and the differential diagnosis can be difficult [20,21]. A mediastinal granuloma is a cluster of enlarged necrotic mediastinal lymph nodes, often paratracheal or subcarinal, that coalesce into a semisolid mediastinal mass and, rarely, fistulize into adjacent structures.…”

Section: Imaging Manifestationsmentioning

confidence: 99%

Endemic pulmonary fungal diseases in immunocompetent patients: an emphasis on thoracic imaging

Mango

Zanetti

Penha

et al. 2019

Expert Review of Respiratory Medicine

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Introduction: Systemic endemic mycoses are prevalent in specific geographical areas of the world and are responsible for high rates of morbidity and mortality in these populations, and in immigrants and travelers returning from endemic regions. The most common fungal infections that can affect the lungs of immunocompetent patients include histoplasmosis, coccidioidomycosis, paracoccidioidomycosis, blastomycosis, sporotrichosis, aspergillosis, and cryptococcosis. Diagnosis and management of these diseases remain challenging, especially in non-endemic areas due to the lack of experience. Therefore, recognition of the various radiologic manifestations of pulmonary fungal infections associated with patients' clinical and epidemiologic history is imperative for narrowing the differential diagnosis. Areas covered: This review discusses the clinical and radiological findings of the main endemic fungal diseases affecting the lungs in immunocompetent patients. Specific topics discussed are their etiology, epidemiology, pathogenesis, clinical manifestations, methods of diagnosis, pathology and main imaging findings, especially in computed tomography. Expert commentary: Imaging plays an important role in the diagnosis and management of pulmonary fungal infection and may reveal useful signs. Although definitive diagnosis cannot be made based on imaging features alone, the use of a combination of epidemiologic, clinical and imaging findings may permit the formulation of an adequate differential diagnosis.

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“…In patients receiving anti-tumor necrosis factor (TNF)-α agents, a miliary pattern on chest imaging is often attributed to tuberculosis. However, fungal infections (histoplasmosis, blastomycosis, and coccidioidomycosis) and metastatic pulmonary disease should also be considered 1,2 .…”

mentioning

confidence: 99%