Autopsy and Case Reports
http://www.autopsyandcasereports.org/article/doi/10.4322/acr.2018.065
Autopsy and Case Reports
Article / Clinical Case Report

Pulmonary histoplasmoma: a disguised malady

Paulo Marcelo Pontes Gomes de Matos; Aloisio Felipe-Silva; José Pinhata Otoch

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Abstract

Histoplasmosis is a mycosis caused by the dimorphic fungus, Histoplasma capsulatum, which is transmitted via dust and aerosols. Lung involvement is the most common, with a varied clinical presentation. Although it is not the only source of infection, H. capsulatum is frequently found in bat guano, which is the reason why it is highly prevalent among caving practitioners. The solitary histoplasmoma of the lung is an unusual and chronic manifestation of this entity, which mimics, or at least is frequently misconstrued, as a malignancy. Almost invariably, the diagnosis of this type of histoplasmosis presentation is achieved after lung biopsy. The authors present the case of a young woman who sought medical care because of chest pain. The diagnostic work-up revealed the presence of a pulmonary nodule. She was submitted to a thoracotomy and wedge pulmonary resection. The histologic analysis rendered the diagnosis of histoplasmoma. This report aims to call attention to this diagnosis as the differential diagnosis of a pulmonary nodule.

Keywords

Histoplasmosis, Fungal, Lung Diseases, Granulomatous Diseases, Chronic

References

Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008;246(3):697-722. 10.1148/radiol.2462070712.18195376

Callister ME, Baldwin DR, Akram AR, et al. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax. 2015;70(8):794-8

McWilliams A, Tammemagi MC, Mayo JR, et al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med. 2013;369(10):910-9. 10.1056/NEJMoa1214726.24004118

Midthun DE, Swensen S, Jett JR, Hartman TE. O-127 Evaluation of nodules detected by screening for lung cancer with low dose spiral computed tomography. Lung Cancer. 2003;41(2):S40. 10.1016/S0169-5002(03)91785-5.

Ohno Y, Nishio M, Koyama H, et al. Dynamic contrast-enhencement CT and MRI for pulmonary nodule assessment. AJR Am J Roentgenol. 2014;202(3):515-29. 10.2214/AJR.13.11888.24555587

Xu DM, van der Zaag-Loonen HJ, Oudkerk M, et al. Smooth or attached solid indeterminate nodules detected at baseline CT screening in the NELSON study: cancer risk during 1 year of follow-up. Radiology. 2009;250(1):264-72. 10.1148/radiol.2493070847.18984780

Good CA, Wilson TW. The solitary circumscribed pulmonary nodule; study of seven hundred five cases encountered roentgenologically in a period of three and one-half years. J Am Med Assoc. 1958;166(3):210-5. 10.1001/jama.1958.02990030008003.13491327

Sacher AG, Dahlberg SE, Heng J, Mach S, Jänne PA, Oxnard GR. Association between younger age and targetable genomic alterations and prognosis in Non-Small-Cell lung cancer. JAMA Oncol. 2016;2(3):313-20. 10.1001/jamaoncol.2015.4482.26720421

Benedict M, Costa J. Metastatic papillary thyroid carcinoma with multifocal synchronous transformation to anaplastic thyroid carcinoma. Case Rep Pathol. 2016;2016:1-5.27774331

Lin JD, Chao TC, Chou SC, Hsueh C. papillary thyroid carcinomas with lung metastases. Thyroid. 2004;14(12):1091-6. 10.1089/thy.2004.14.1091.15650364

Oladele RO, Ayanlowo OO, Richardson MD, Denning DW. Histoplasmosis in Africa: An emerging or neglected disease? PLoS Negl Trop Dis. 2018;12(1):1-12. 10.1371/journal.pntd.0006046.29346384

Emmons CW. Association of bats with histoplasmosis. Public Health Rep. 1958;73(7):590-5. 10.2307/4590196.13568009

Benedict K, Mody RK. Epidemiology of histoplasmosis outbreaks, United States, 1938-3013. Emerg Infect Dis. 2016;22(3):370-8. 10.3201/eid2203.151117.26890817

Cano MV, Hajjeh RA. The epidemiology of histoplasmosis: a review. Semin Respir Infect. 2001;16(2):109-18. 10.1053/srin.2001.24241.11521243

Erkens K, Lademann M, Tintelnot K, Lafrenz M, Kaben U, Reisinger EC. Histoplasmosis group disease in bat researchers returning from Cuba. Dtsch Med Wochenschr. 2002;127(1-2):21-5. 10.1055/s-2002-19428.11905225

Huhn GD, Austin C, Carr M, et al. Two outbreaks of occupationally acquired histoplasmosis: more than workers at risk. Environ Health Perspect. 2005;113(5):585-9. 10.1289/ehp.7484.15866767

Nygård K, Brantsaeter A, Feruglio S, et al. Histoplasmosis among travellers to Central America. Tidsskr Nor Laegeforen. 2006;126(21):2838-42.17086244

Disalvo AF. Mycotic morbidity - an occupational risk for mycologists. Mycopathologia. 1987;99(3):147-53. 10.1007/BF00437437.3309663

Tesh RB, Schneidau JD Jr. Naturally occurring histoplasmosis among bat colonies in the Southeastern United States. Am J Epidemiol. 1967;86(3):545-51. 10.1093/oxfordjournals.aje.a120764.5625363

Valdez H, Salata RA. Bat-associated histoplasmosis in returning travelers: case presentation and description of a cluster. J Travel Med. 1999;6(4):258-60. 10.1111/j.1708-8305.1999.tb00529.x.10575176

Guimarães AJ, Nosanchuk JD, Zancopé-Oliveira RM. Diagnosis of Histoplasmosis. Braz J Microbiol. 2006;37(1):1-13. 10.1590/S1517-83822006000100001.20445761

Nelson MR. The mummy’s curse: historical cohort study. BMJ. 2002;325(7378):1482-4. 10.1136/bmj.325.7378.1482.12493675

McCann J. The Pharaoh’s Curse: What do King Tut, Johnny Cash, and Bob Dylan have in common? Chapel Hill: Endeavors; 2009 [cited 2018 Nov 27. Available from: http://endeavors.unc.edu/fall2009/the_pharaohs_curse.php

Unis G, Pêgas KL, Severo LC. Histoplasmoma Pulmonar no Rio Grande do Sul. Rev Soc Bras Med Trop. 2005;38(1):11-4. 10.1590/S0037-86822005000100003.15717088

Sutaria MK, Polk JW, Reddy P. Focalized Pulmonary Histoplasmosis (Coin Lesion): A report of 58 cases. Chest. 1972;61(4):361-4. 10.1378/chest.61.4.361.5020255

Galetta D, Pelosi G, Nebuloni M, Spaggiari L. Challenging diagnosis of an unusual solitary pulmonary nodule. Thorac Cardiovasc Surg. 2007;55(2):120-9. 10.1055/s-2006-924407.17377868

Wheat LJ, Freifeld AG, Kleiman MB, et al. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007;45(7):807-25. 10.1086/521259.17806045

Ye C, Zhang G, Wang J, Chai Y. Histoplasmosis presenting with solitary pulmonary nodule: Two cases mimicking pulmonary metastases. Niger J Clin Pract. 2015;18(2):304-6. 10.4103/1119-3077.151075.25666013

Almeida MA, Pizzini CV, Damasceno LS, et al. Validation of western blot for Histoplasma capsulatum antibody detection assay. BMC Infect Dis. 2016;16(1):87. 10.1186/s12879-016-1427-0.26905567

Hage CA, Wheat LJ, Loyd J, Allen SD, Blue D, Knox KS. Pulmonary histoplasmosis. Semin Respir Crit Care Med. 2008;29(2):151-65. 10.1055/s-2008-1063854.18365997

Guarner J, Brandt ME. Histopathologic diagnosis of fungal Infections in the 21st century. Clin Microbiol Rev. 2011;24(2):247-80. 10.1128/CMR.00053-10.21482725

Richmond BW, Worrell JA, Bastarache JA, Gervich DH, Slattery WR, Loyd JE. Histoplasmomas of Uncommon Size. Chest. 2013;143(6):1795-8. 10.1378/chest.12-2071.23732591

Wheat LJ, Freifeld AG, Kleiman MB, et al. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the infectious diseases society of America. Clin Infect Dis. 2007;45(7):807-25. 10.1086/521259.17806045

 

 

 

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