Nondisseminated histoplasmosis of the trachea

Abstract

Histoplasma capsulatum can rarely affect the trachea. We report the case of a 68-year-old woman with rheumatoid arthritis on immunosuppressive therapy who presented with fevers, worsening shortness of breath, nonproductive cough and subjective throat hoarseness and fullness. Chest computed tomography demonstrated no tracheal findings. Bronchoscopy found mucosal irregularity, nodularity and vesicular regions in the proximal trachea extending seven centimeters distal to the vocal cords. Also seen was an edematous, exudative left vocal cord with polyps and an ulcerative lesion. Silver staining and culture and wash of the tracheal biopsy revealed Histoplasma capsulatum. She was treated with oral itraconazole then briefly on intravenous amphotericin for rising Histoplasma urinary antigen levels. She continued treatment 24 months following diagnosis with minimal dyspnea. Histoplasma tracheitis has been proposed as an indicator of disseminated infection. However, our patient did not demonstrate other organ manifestations. Histoplasma tracheitis should be considered in a differential diagnosis of tracheal lesions even in the absence of systemic involvement.

Unusual cause of hoarse voice: Laryngotracheal histoplasmosis in renal transplant patient

“…Tracheal involvement in histoplasmosis has rarely been reported. Bhojwani et al from the United States, described an isolated tracheal histoplasmosis in an immunocompetent patient 3 . This rare presentation of isolated tracheal Histoplasmosis raises the possibility of direct submucosal inoculation of the fungus rather than invading the bronchus and lung parenchyma.…”

Infections causing central airway obstruction: role of bronchoscopy in diagnosis and management

“…In patients with airway cryptococcal infections, the bronchoscopic appearance has been reported as whitish or yellowish masses, mucous plugs, red or white thrush-like plaques, mucosal granularity, white granulation tissue, elevated ulcerated lesions, and polypoid masses ( Figure 2) (6,44,64,(79)(80)(81). Endobronchial histoplasmosis disease is rare but submucosal grayish nodules, ulcers, vesicular lesions as well as masses have been described (82)(83)(84)(85). Endobronchial disease with stenosis due to fibrosing mediastinitis has also been reported (86).…”