Chronic pulmonary histoplasmosis in Brazil: report of two cases with cavitation diagnosed by transthoracic needle biopsy

Severo, Luiz Carlos; Rizzon, Carlos Fernando Carvalho; Roesch, Eliane Würdig; Oliveira, Flávio de Mattos; Porto, Nelson da Silva

doi:10.1590/s0036-46651997000500009

Cited by 11 publications

(11 citation statements)

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“…(12) Only thirteen cases of CPH have been reported in Brazil. (5) Of these, five were CPH with cavitation: three occurring in the state of Rio de Janeiro, (13) and two in the state of Rio Grande do Sul. (5) These two states weight loss Itraconazole -9m ET: empirical treatment (for tuberculosis); M: male; m: months to fibrotic retraction around the emphysematous bulla, which is a pattern characteristic of pulmonary histoplasmosis.…”

Section: Discussionmentioning

confidence: 99%

“…(5) Of these, five were CPH with cavitation: three occurring in the state of Rio de Janeiro, (13) and two in the state of Rio Grande do Sul. (5) These two states weight loss Itraconazole -9m ET: empirical treatment (for tuberculosis); M: male; m: months to fibrotic retraction around the emphysematous bulla, which is a pattern characteristic of pulmonary histoplasmosis. (4) Due to its high sensitivity, the immunodiffusion test is a good trial method for CPH, presenting positive results in virtually 100% of cases in which the diagnosis is later confirmed.…”

Section: Discussionmentioning

confidence: 99%

“…Only one patient underwent surgery, which led to the death of that patient. (5) We would like to highlight the fact that the presence of cavitary lesions in the upper lobes of patients with chronic obstructive pulmonary disease, especially those who present negative for acid-fast bacilli sputum smear microscopy and tuberculin skin test results and reside in endemic areas, should lead to a hypothetical diagnosis of CPH. In this group of patients, only 5% of the cases are likely to be infected with tuberculosis.…”

Section: Discussionmentioning

confidence: 99%

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Histoplasmose pulmonar cavitária crônica simulando tuberculose

Unis

Severo

2005

J. bras. pneumol.

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Objective: To evaluate cases of chronic pulmonary histoplasmosis diagnosed in recent years at the Complexo Hospitalar Santa Casa in Porto Alegre, in the state of Rio Grande do Sul, Brazil. Methods: Cases diagnosed at the Santa Casa Hospital Complex within the last 25 years were reviewed. Four cases in which the diagnosis was made through histopathological analysis or culture and confirmed by with serologic testing are described. Cases from the Brazilian literature are also discussed. Results: The principal clinical manifestations were cough, dyspnea, fever, anorexia and weight loss. Among the radiological findings were emphysema, cystic cavities, bronchiectasis and pleural thickening. All patients had an epidemiological history of contact with chicken feces. One of the patients presented Aspergillus fumigatus colonization of cavities. Conclusion: Chronic pulmonary histoplasmosis must be considered in patients with chronic obstructive pulmonary disease presenting cavitary lesions of the lung, sputum smear microscopy negative for acid-fast bacilli and negative tuberculin skin test. Hemoptysis occurring in the presence of cured or fading pulmonary lesions is suggestive of Aspergillus colonization. Original ArticleJ Bras Pneumol. 2005;31(4):318-24Chronic pulmonary histoplasmosis mimicking tuberculosis 319

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Histoplasmose pulmonar cavitária crônica simulando tuberculose

Unis

Severo

2005

J. bras. pneumol.

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“…(10) The radiological aspect of the initial lesion is characterized by foci of interstitial inflammatory infiltrate, adjacent to emphysematous bullae, and the lesion commonly affects the apical and apicoposterior segments of the upper lobes. (2,5,6,10) Thickening of the walls of the bullae is common and is followed by necrosis and increased fibrosis, which leads to lung volume loss. This continuous process culminates with large and persistent cavities that can affect an entire lobe.…”

Section: Acute Symptomatic H Capsulatum Infection Ismentioning

confidence: 99%

“…(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). …”

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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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“Polka Dot Macrophages” on cytology of bilateral adrenal masses—Nailing disseminated histoplasmosis

Grover

Selhi

Sood

et al. 2017

Diagnostic Cytopathology

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Histoplasma capsulatum is a saprophytic fungus that in immunocompetent individuals causes self-limited pulmonary infection; however, in immunosuppressed patients involvement of the reticuloendothelial system, alimentary tract, urinary tract, and central nervous system is fairly common. Rarely patients present with bilateral adrenal masses which mimic tuberculosis and metastasis on radiology because of associated central necrosis. Ultrasound guided FNAC aided by special stains like Periodic Acid Schiff (PAS) and Gomori Methenamine Silver (GMS) may help in early diagnosis in such dubious cases. Polka dot macrophages were the clue to diagnosis of histoplasmosis on toluidine blue rapid staining, Hematoxylin & Eosin, and Pap stained smears. We report this case because of its rarity, diagnostic difficulty on radiology, and rapidity of diagnosis by FNA due of its characteristic cytomorphology.

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Chronic pulmonary histoplasmosis in Brazil: report of two cases with cavitation diagnosed by transthoracic needle biopsy

Cited by 11 publications

References 4 publications

Histoplasmose pulmonar cavitária crônica simulando tuberculose

Histoplasmose pulmonar cavitária crônica simulando tuberculose

Histoplasmose pulmonar cavitária crônica

“Polka Dot Macrophages” on cytology of bilateral adrenal masses—Nailing disseminated histoplasmosis

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