Disseminated histoplasmosis in an immunocompetent haweli dweller: A diagnosis and follow-up by endoscopic ultrasound-guided fine-needle aspiration

Abstract

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is nowadays widespread minimally invasive procedure for diagnosing a large number of benign as well as malignant lesions. We report a case of a 62-year-old immunocompetent elderly male, who presented with high-grade fever, hepatosplenomegaly and mediastinal and intra-abdominal lymph nodes. He was residing in an old haweli with bats infestation. EUS-FNA of the subcarinal and the preaortic lymph node clinched the diagnosis. A rapid on-site evaluation of the cytology material revealed organisms conforming to the morphology of Histoplasma capsulatum. The patient was immediately started on amphotericin B and itraconazole and responded well. In this case, we found the role of EUS-FNA not only in diagnosis, but also in the follow-up of the patient.

Histoplasmosis of mesenteric lymphnode in an immunocompromised adult: FNAC diagnosis and its differentials

“…Histoplasmosis is an opportunistic fungal infection of worldwide distribution which is caused by the intracellular, thermally dimorphic fungus Histoplasma capsulatum. 1 The infection is acquired through respiratory route with the inhalation of spores of H. capsulatum which are present in soils contaminated by bird and bat excreta. 2 The clinical spectrum ranges from mild respiratory illness to more severe disseminated forms, which in turn, can have an acute, subacute or chronic presentation.…”

“…2 The clinical spectrum ranges from mild respiratory illness to more severe disseminated forms, which in turn, can have an acute, subacute or chronic presentation. 3 Disseminated Histoplasmosis is defined as Histoplasmosis affecting more than one site 1 and may affect lungs, lymph node, liver, spleen, bone marrow, adrenal gland, gastrointestinal tract as well as mucous membrane of the oral cavity. [2][3][4] In immunosuppressed individuals and extremes of age, they usually run a severe and progressive, often disseminated course.…”

“…2,4 In India, which is nonendemic for Histoplasmosis, reported cases are sporadic. 1 Fine needle aspiration cytology can often clinch the diagnosis accurately with the added advantage of being a cheap, rapid and non-invasive procedure.…”

“…That which we call a rose…”: A critical analysis of rapid on‐site evaluation

“…Of the 16 articles published in 6 cytology specialty journals ( Acta Cytologica, Cytopathology, Journal of Cytology, Diagnostic Cytopathology, Cancer Cytopathology , and CytoJournal ) during these 18 months, only 2 offer an actual definition of ROSE and these 2 articles are from the same group. In the remaining 14 articles, the term is used to describe the assessment of cytologic adequacy, immediate diagnosis, preliminary diagnosis, the interchangeable use of diagnosis and adequacy in the same article, standard of practice with no further definition, and as a way to ensure adequate cell blocks.…”