Endobronchial Valve Use in Persistent Pneumothorax (Bronchopleural Fistula) Secondary to Histoplasmosis

Patel, Niral; Worden, Andrew; Patel, Rajul; Diaz-Mendoza, Javier; Stagner, Lisa

doi:10.1378/chest.1993692

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“…Spontaneous pneumothorax is a rare presentation of chronic cavitary pulmonary histoplasmosis. There are only two other similar case reports upon literature search, making this a relatively unique case [7,8]. The first case report, published in 1956 from Vanderbilt University Hospital, was a 31-year-old female who initially developed constitutional symptoms and was found to have nodular infiltrations in the left lung apex [7].…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous pneumothorax secondary to chronic cavitary pulmonary histoplasmosis

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2020

Journal of Community Hospital Internal Medicine Perspectives

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Histoplasma capsulatum is a dimorphic fungus that causes histoplasmosis. Chronic cavitary pulmonary histoplasmosis is rare, and typically manifests as apical cavitary lesions in patients with pre-existing chronic obstructive pulmonary disease. We report a case involving a 60-year-old female who presented to our facility with acute onset of dyspnea and dry cough. Chest x-ray revealed a large left-sided pneumothorax with nearly complete collapse of the left lung. A chest computed tomography scan revealed a left upper lobe cavitary lesion with a bronchopleural fistula. After thoracic surgical bleb resection, a surgical specimen sent for biopsy was positive for Histoplasma capsulatum. The patient's pneumothorax was subsequently diagnosed as chronic cavitary pulmonary histoplasmosis, and itraconazole treatment was initiated. After admission, the patient underwent a thoracotomy with decortication to improve lung expansion; however, the patient's pneumothorax persisted. After a prolonged hospital stay and serial chest x-rays that showed stable residual pneumothorax, the patient was discharged to a long-term acute care facility and itraconazole treatment was continued. Two months after discharge, a repeat chest x-ray showed resolution of her left-sided pneumothorax. This case report highlights the importance of considering pulmonary histoplasmosis (or other endemic pulmonary fungal infections) when a patient presents with apical cavitary lesions.

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Section: Discussionmentioning

confidence: 99%

“…The second case report primarily highlighted the use of endobronchial valves in managing persistent bronchopleural fistulas [ 8 ]. The patient was a 60-year-old Caucasian female with a history of rheumatoid arthritis who presented to the hospital with acute diverticulitis.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous pneumothorax secondary to chronic cavitary pulmonary histoplasmosis

Geurkink

Cler

2020

Journal of Community Hospital Internal Medicine Perspectives

View full text Add to dashboard Cite

show abstract

Endobronchial Valve Use in Persistent Pneumothorax (Bronchopleural Fistula) Secondary to Histoplasmosis

Cited by 1 publication

References 0 publications

Spontaneous pneumothorax secondary to chronic cavitary pulmonary histoplasmosis

Spontaneous pneumothorax secondary to chronic cavitary pulmonary histoplasmosis

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