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Pulmonary histoplasmosis mimicking carcinoma lung.

George P, Nayak N, Anoop TM, Gopi N, Vikram HP, Sankar A - Lung India (2015 Nov-Dec)

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India.

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Sir, Human histoplasmosis is an endemic mycosis caused by a dimorphic fungus... Human histoplasmosis is an endemic mycosis caused by a dimorphic fungus-limiting pulmonary illness... She was conservatively managed at local hospital, but her symptoms were deteriorating with increased tiredness and occasional cough... It was associated with loss of weight and loss of appetite... There was no hepatosplenomegaly... Breath sounds were decreased in the right lower zone... The differential diagnosis of histoplasmosis include malignancy, tuberculosis or sarcoidosis... Culture remains the gold standard for the diagnosis of histoplasmosis, but it requires a lengthy incubation period... Most infections are self-limited and require no therapy... However, patients who are immunocompromised usually require antifungal therapy... Acute severe pulmonary histoplasmosis is managed with liposomal amphotericin followed by itraconazole for 12 weeks and chronic cavitory pulmonary histoplasmosis is managed with itraconazole for 12 months... Our case revealed that diagnosis of histoplasmosis is a major challenge even in the present era and required multidisciplinary team with major resource facilities... Mortality associated with severe histoplasmosis without treatment is 80% but can be reduced to <25% with anti-fungal therapy.

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Related in: MedlinePlus

(a and b) Computed tomography scan of thorax showing mass lesion in the anterior mediastinum and multiple well-defined pleural-based lesions along the right hemithorax
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Figure 1: (a and b) Computed tomography scan of thorax showing mass lesion in the anterior mediastinum and multiple well-defined pleural-based lesions along the right hemithorax

Mentions: A 70-year-old South Indian lady who was apparently normal 3 months before presented with neck pain and generalized fatigue for 2-month duration. She was conservatively managed at local hospital, but her symptoms were deteriorating with increased tiredness and occasional cough. It was associated with loss of weight and loss of appetite. There was no history of fever, dyspnea, night sweats, dysphagia and hemoptysis. She is a farmer by occupation who was actively farming until 10 years back. But she had no history of smoking or working in the mining industry. She had no history of tuberculosis or other lung disease in her family. She was afebrile and her vitals were stable. General examination revealed grade 2 clubbing and there was no pallor, icterus or generalized lymphadenopathy. There was no hepatosplenomegaly. Breath sounds were decreased in the right lower zone. The rest of the respiratory examination was unremarkable. Routine blood investigations revealed hemoglobin of 12.1 gm%, total count of 10,000/cmm (neutrophils: 66.9%, lymphocytes: 21.3%, eosinophil 4.2%, monocytes: 7.2%, basophil: 0.4%) and Erythrocyte sedimentation rate of 90. Viral markers including HIV, HBsAg, and HCV were negative. Chest X-ray revealed widening of mediastinum, upper zone collapse and bilateral lower rib erosion. Contrast-enhanced CT chest was performed which revealed 6 × 3 cm ill-defined mass lesion in the anterior mediastinum having broad area of contact with pulmonary artery and aortic arch [Figure 1a]. Multiple well-defined pleural based lesions are seen along the right hemithorax and largest measuring 7 × 5 cm [Figure 1b]. Few small nodular lesions in the bilateral lower zones and bronchiectasis seen in the right middle zone. Fine needle aspiration cytology smears done from the pleural-based nodules showed macrophages, that contained numerous small-sized intracellular organisms having a single nucleus surrounded by a clear halo [Figure 2]. Multinucleate giant cells and epithelioid histiocytes were also noted. Gomorial methenamine silver stain shows fungal organisms as rounded black colored structures in the cytoplasm confirming the diagnosis of histoplasmosis [Figure 3].


Pulmonary histoplasmosis mimicking carcinoma lung.

George P, Nayak N, Anoop TM, Gopi N, Vikram HP, Sankar A - Lung India (2015 Nov-Dec)

(a and b) Computed tomography scan of thorax showing mass lesion in the anterior mediastinum and multiple well-defined pleural-based lesions along the right hemithorax
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663885&req=5

Figure 1: (a and b) Computed tomography scan of thorax showing mass lesion in the anterior mediastinum and multiple well-defined pleural-based lesions along the right hemithorax
Mentions: A 70-year-old South Indian lady who was apparently normal 3 months before presented with neck pain and generalized fatigue for 2-month duration. She was conservatively managed at local hospital, but her symptoms were deteriorating with increased tiredness and occasional cough. It was associated with loss of weight and loss of appetite. There was no history of fever, dyspnea, night sweats, dysphagia and hemoptysis. She is a farmer by occupation who was actively farming until 10 years back. But she had no history of smoking or working in the mining industry. She had no history of tuberculosis or other lung disease in her family. She was afebrile and her vitals were stable. General examination revealed grade 2 clubbing and there was no pallor, icterus or generalized lymphadenopathy. There was no hepatosplenomegaly. Breath sounds were decreased in the right lower zone. The rest of the respiratory examination was unremarkable. Routine blood investigations revealed hemoglobin of 12.1 gm%, total count of 10,000/cmm (neutrophils: 66.9%, lymphocytes: 21.3%, eosinophil 4.2%, monocytes: 7.2%, basophil: 0.4%) and Erythrocyte sedimentation rate of 90. Viral markers including HIV, HBsAg, and HCV were negative. Chest X-ray revealed widening of mediastinum, upper zone collapse and bilateral lower rib erosion. Contrast-enhanced CT chest was performed which revealed 6 × 3 cm ill-defined mass lesion in the anterior mediastinum having broad area of contact with pulmonary artery and aortic arch [Figure 1a]. Multiple well-defined pleural based lesions are seen along the right hemithorax and largest measuring 7 × 5 cm [Figure 1b]. Few small nodular lesions in the bilateral lower zones and bronchiectasis seen in the right middle zone. Fine needle aspiration cytology smears done from the pleural-based nodules showed macrophages, that contained numerous small-sized intracellular organisms having a single nucleus surrounded by a clear halo [Figure 2]. Multinucleate giant cells and epithelioid histiocytes were also noted. Gomorial methenamine silver stain shows fungal organisms as rounded black colored structures in the cytoplasm confirming the diagnosis of histoplasmosis [Figure 3].

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir, Human histoplasmosis is an endemic mycosis caused by a dimorphic fungus... Human histoplasmosis is an endemic mycosis caused by a dimorphic fungus-limiting pulmonary illness... She was conservatively managed at local hospital, but her symptoms were deteriorating with increased tiredness and occasional cough... It was associated with loss of weight and loss of appetite... There was no hepatosplenomegaly... Breath sounds were decreased in the right lower zone... The differential diagnosis of histoplasmosis include malignancy, tuberculosis or sarcoidosis... Culture remains the gold standard for the diagnosis of histoplasmosis, but it requires a lengthy incubation period... Most infections are self-limited and require no therapy... However, patients who are immunocompromised usually require antifungal therapy... Acute severe pulmonary histoplasmosis is managed with liposomal amphotericin followed by itraconazole for 12 weeks and chronic cavitory pulmonary histoplasmosis is managed with itraconazole for 12 months... Our case revealed that diagnosis of histoplasmosis is a major challenge even in the present era and required multidisciplinary team with major resource facilities... Mortality associated with severe histoplasmosis without treatment is 80% but can be reduced to <25% with anti-fungal therapy.

No MeSH data available.


Related in: MedlinePlus