Pitfalls in diagnosis of pulmonary histoplasmosis

Santos, José Wellington Alves dos; Neves, Kelly Ribeiro; Machado, Fabiani Palagi; Schaich, Felipe; Gazzoni, Marcos Ferreira; Dalcin, Tiago Chagas; Toso, Rosane Beatriz; Cibin, Luiz Fernando Ximenes; Silva, Lauro Vinícius Schvarcz da; Siqueira, Márcio José; Melo, Carlos Renato de; Scalcon, Márcia Regina Rosa; Oliveira, L. T. O.; Marchiori, Roseane Cardoso; Rocha, Marta Pires da

doi:10.1016/j.rmedx.2006.11.005

Cited by 2 publications

(3 citation statements)

References 11 publications

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“…It is more common for reactivation to occur when a patient has become immunosuppressed, most commonly secondary to human immunodeficiency virus, however, this patient had no history of this. It has been reported that histoplasmosis can present as an asymptomatic solitary pulmonary nodule, often calcified and with a fibrous capsule 4. However, as demonstrated above, this patient had a large spiculated lesion, which is highly suspicious for lung cancer.…”

Section: Discussionmentioning

confidence: 65%

Histoplasmosis mimicking primary lung neoplasm

et al. 2014

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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

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Section: Discussionmentioning

confidence: 65%

Histoplasmosis mimicking primary lung neoplasm

et al. 2014

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“…(2,16) Culture on Sabouraud dextrose agar is the gold standard for the etiologic diagnosis, although the result might not be known for 2-4 weeks. (10,17) The immunodiffusion test is appropriate to screen patients, and the sensitivity of the test is approximately 100%; the relevance of the test is greater in areas in which the prevalence of the fungus is low. (2) Histoplasmin skin test can yield false-negative results in patients with CCPH and therefore is inappropriate as a screening test.…”

Section: Discussionmentioning

confidence: 99%

“…(2) Histoplasmin skin test can yield false-negative results in patients with CCPH and therefore is inappropriate as a screening test. (17) The use of the urinary antigen test has been limited because the antigen can be detected in only 10-20% of CCPH patients. (10) The treatment of choice for CCPH is itraconazole, at a dose of 400-600 mg/day, for 1-2 years.…”

Section: Discussionmentioning

confidence: 99%

Histoplasmose pulmonar cavitária crônica

Santos

Michel²,

Lazzarotto³

et al. 2009

J. bras. pneumol.

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A 69-year-old female smoker (30 packyears) homemaker from São Sepe, Brazil, presented with rheumatoid arthritis for 14 years. The patient had undergone a thyroidectomy 20 years before. The epidemiological history was not clear regarding possible fungal exposure. The patient had been experiencing progressive dyspnea, productive cough, recurrent respiratory infections, loss of appetite, nausea and weight loss for 4 years. The patient was using levothyroxine, calcitriol and prednisone 15 mg/day; however, she had previously used methotrexate. Physical examination revealed that the patient had lost weight (patient weight at the time was 30 kg, and body mass index was 14 kg/m 2 ). No cervical lymph node enlargement, supraclavic- IntroductionHistoplasmosis is a systemic mycosis caused by the thermally dimorphic fungus Histoplasma capsulatum, which can be isolated from soil contaminated with droppings from birds or bats. (1,2) Similar to other systemic mycoses, the initial exposure is through inhalation, and pulmonary impairment is the predominant form of presentation of the disease. Large outbreaks of the disease have been reported; however, most of the infections are sporadic. (3) Chronic pulmonary histoplasmosis is a rare clinical manifestation of the disease that affects the upper lobes of the lungs and can present as cavitation and fibrosis. (4)(5)(6)(7) We report the case of a female patient with chronic cavitary pulmonary histoplasmosis (CCPH). AbstractHistoplasmosis is a systemic mycosis caused by the thermally dimorphic fungus Histoplasma capsulatum, which can be isolated from soil contaminated with droppings from birds or bats. Chronic cavitary pulmonary histoplasmosis is one of the rarest clinical presentations of this disease. The differential diagnosis with tuberculosis should be made in patients presenting with cavitated lesions in upper lung segments. We report the case of a female patient with chronic cavitary pulmonary histoplasmosis who had presented with progressive dyspnea and worsening of the radiological pattern over a four-year period.Keywords: Histoplasmosis; Cavitation; Pulmonary emphysema. ResumoA histoplasmose é uma micose sistêmica causada pelo fungo dimórfico térmico Histoplasma capsulatum, que pode ser isolado a partir de solo contaminado com excrementos de aves e morcegos. Dentre as apresentações clínicas dessa doença, a histoplasmose pulmonar cavitária crônica (HPCC) é uma manifestação rara. O diagnóstico diferencial com tuberculose deve ser realizado em pacientes que apresentam lesões cavitadas nos segmentos pulmonares superiores. É relatado um caso de uma paciente com HPCC que apresentou dispneia progressiva e piora do padrão radiológico em quatro anos de evolução da doença.

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Pitfalls in diagnosis of pulmonary histoplasmosis

Cited by 2 publications

References 11 publications

Histoplasmosis mimicking primary lung neoplasm

Histoplasmosis mimicking primary lung neoplasm

Histoplasmose pulmonar cavitária crônica

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