Histoplasmosis mimicking metastatic spinal tumour

Abstract

Histoplasmosis is an infection caused by a fungus called Histoplasma. Diagnosis of histoplasmosis is based on the culture of biological samples and detection of fungus in tissues. Histoplasmosis can mimic malignant lesions. We report a 65-year-old, immunocompetent, male patient with back pain. We describe the main clinical and radiological characteristics in our patient who had vertebral histoplasmosis that mimicked cancer. A computed tomography scan showed lytic lesions of the right side of T4, T5, and T6 vertebral bodies. Magnetic resonance imaging displayed abnormal marrow signals in T4, T5, and T6 vertebral bodies (low signal on T1, high on T2 and short time inversion recovery (STIR)). Which was mimicking malignancy, such as haematological malignancy and metastatic bone cancer. Therefore, thoracic spinal surgery using the anterior approach was performed. An intraoperative frozen section examination and routine postoperative pathology showed thoracic histoplasmosis infection. Treatment of histoplasmosis was performed with oral itraconazole. The lesions did not progress and the patient symptomatically improved at a follow-up of 26 months.

Disseminated histoplasmosis presenting as pyoderma gangrenosum‐like ulcers in an apparently immunocompetent patient: multiple red herrings presenting a diagnostic challenge

“…Bone involvement is also extremely rare, manifesting as carpal tunnel syndrome, septic arthritis, or osteomyelitis. There are only a few reports of osteolytic lesions mimicking malignancy, as in our case 5,6 . Gastrointestinal involvement, reported to occur in 70–90% of patients in autopsy studies, is symptomatic in only 3–12% of cases and shows nonspecific findings on colonoscopy 7 .…”

Disseminated Histoplasmosis Infection Diagnosed by Metagenomic Next-Generation Sequencing: A Case Report

“…Histoplasma capsulatum -caused spinal infection mimicked Pott’s disease, 34 and the bone lesion may be misdiagnosed as a metastatic spinal tumor. 35 Misdiagnosed and overlooked cases can result in insufficient treatment and ultimately lead to patient fatalities. Clinicians in non-endemic regions may lack adequate knowledge of histoplasmosis, leading to underdiagnosis or misdiagnosis.…”

Gastrointestinal histoplasmosis complicating pediatric Crohn disease: A case report and review of literature

“…Histoplasmosis is an infection caused by inhalation of spores from the fungus Histoplasma capsulatum ( H. capsulatum ) , found in soil enriched with bird and bat droppings and is endemic to the central and eastern states, prevalent in the Ohio and Mississippi River Valleys[ 1 , 2 ]. Clinical manifestations are typically self-limiting in immunocompetent children, whereas immunocompromised children are likely to present with more severe or disseminated disease and may be indistinguishable from malignancy or tuberculosis[ 3 , 4 ]. Single-organ histoplasmosis is rare, primarily affecting the lungs, occasionally lymph nodes, liver, bone marrow, skin and mucosal membranes[ 5 - 8 ].…”