Fibrosing Mediastinitis: Uncommon Life-threatening Complication of Histoplasmosis

Khalid, Muhammad; Khan, Imran; Rahman, Zia Ur; Alazzeh, Ahmad; Youssef, Dima

doi:10.7759/cureus.2532

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…Itraconazole has demonstrated success in treating FM in isolated case reports [ 15 , 16 ]. However, in a larger case series, only three of 34 patients demonstrated radiographic improvement, with only one of the three reporting improvement in symptoms [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Fibrosing Mediastinitis Presenting With Superior Vena Cava Syndrome

Park¹,

Lucaj²,

Denchev³

2022

Cureus

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Fibrosing mediastinitis (FM) is an uncommon diagnosis that involves the proliferation of extensive, dense fibrous tissue in the mediastinum. FM accounts for less than 1% of people with prior infection by Histoplasma capsulatum that develop hypersensitivity immune responses to antigens released during the initial exposure. Other causes include tuberculosis, blastomycosis, sarcoidosis, radiation, and idiopathic. We describe FM presenting with superior vena cava (SVC) syndrome. A 66-year-old Caucasian male presented with a one-week history of progressively worsening facial swelling associated with dysphonia, bilateral ptosis, dyspnea on exertion, and unintentional weight loss of 30 pounds within the past three months. He had a 40-pack-year smoking history and a past medical history of essential hypertension, peripheral vascular disease, and bilateral internal carotid artery stenosis. The CT chest demonstrated non-specific soft tissue extending throughout the mediastinum and towards the right hilar region, complicated by severe attenuation of the superior vena cava and a 2.4 cm × 1.6 cm necrotic lymph node. The mediastinum had hyperemic and desmoplastic changes heavily encased in venous collaterals. L4 lymph node pathological evaluation demonstrated sinus histiocytosis and reactive lymphoid hyperplasia without signs of malignancy or atypia. The patient was treated with corticosteroid and diuretic therapy to achieve intermittent symptomatic relief, but continued to decline clinically, ultimately leading to his demise. The diagnosis of FM is best obtained through CT chest with intravenous contrast to demonstrate abnormal mediastinal tissue and possible structural compromise. A biopsy of the mediastinal tissue may also help rule out malignancy. Only a few case reports have demonstrated mixed symptomatic and radiologic responses to anti-inflammatory and/or antifungal treatment. Even non-surgical and surgical interventions have shown inconsistent efficacy, with frequent restenosis warranting re-exploration.

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Section: Discussionmentioning

confidence: 99%

Fibrosing Mediastinitis Presenting With Superior Vena Cava Syndrome

Park¹,

Lucaj²,

Denchev³

2022

Cureus

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“…Most often, the granuloma is symptomatic secondary to compression of adjacent structures (the esophagus, pulmonary vessels, and trachea), and in these situations, itraconazole for 6-12 weeks is prescribed frequently. Surgical resection of obstructive masses should be considered in the setting of obstruction or in whom a fistula to adjacent structures with drainage of necrotic material has occurred [38,39].…”

Section: Mediastinal Granuloma Mediastinal Lymphadenitis and Fibrosin...mentioning

confidence: 99%

“…Fibrosing mediastinitis is a rare disorder characterized by an excessive fibrotic reaction in the mediastinum, which results from an exaggerated host response to a prior infection located at mediastinal lymph nodes [39].…”

Section: Mediastinal Granuloma Mediastinal Lymphadenitis and Fibrosin...mentioning

confidence: 99%

Histoplasmosis: An Overview Treatment of Histoplasmosis

Man¹,

Todea²,

Motoc³

et al. 2023

Infectious Diseases

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In 2000, the Infectious Diseases Society of America (IDSA) published a clinical practice guideline on managing patients with histoplasmosis and, in 2020, the first global guideline for diagnosing and managing disseminated histoplasmosis in people living with HIV (PLHIV). The classification of pulmonary histoplasmosis is done after clinical presentation and imaging. The optimal treatment depends on the patient’s clinical syndrome: acute mild/moderate, acute moderately/severe, chronic cavitary pulmonary, mediastinal lesions, or broncholithiasis. Asymptomatic patients or patients with mild cases of histoplasmosis with symptoms lasting less than four weeks do not usually require antifungal treatment. When necessary, itraconazole is the treatment of choice in mild to moderate acute forms of the disease, often for six weeks. For severe histoplasmosis, amphotericin B is recommended as initial therapy, followed by itraconazole as consolidation therapy. Long-term treatment for at least 12 months is recommended in patients with chronic cavitary histoplasmosis.

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“…It grows under varied soil and climatic conditions, but its productivity is generally limited by abiotic and biotic stresses, as it has to face vagaries of nature during its yearlong life in the field. National production of it is 366.80 million tones and productivity is 69.20 t/ha whereas productivity in Bihar is 50 t/ha (2014-15, Indian Sugar February, 2016. In India 10 -30 per cent of sugarcane area is affected by water logging which is one of the major constraints affecting crop productivity in the IndoGangetic belt and the coastal area about 73 per cent annual rainfall in India is received during the southwest monsoon (June to September) which is primary cause for water logging.…”

Section: Introductionmentioning

confidence: 99%