Sarcoidlike Manifestations of Histoplasmosis

Wheat, L. Joseph; French, Morris L. V.; Wass, Justin L.

doi:10.1001/archinte.1989.00390110027007

Cited by 29 publications

(4 citation statements)

References 30 publications

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“…In the case of histoplasmosis, as noted in our case report, numerous small 2-4 µm in diameter yeast-like microorganisms may be seen within macrophage, multinucleate giant cells, or within fibrous tissue [48]. Patients who have hilar lymphadenopathy, arthralgia, and erythema nodosum can be mistakenly given the diagnosis of sarcoidosis [49,50]. Also, the early clinical manifestations of disseminated histoplasmosis are nonspecific, often leading to diagnostic difficulty and misdiagnosis as tuberculosis, lymphoma or metastatic malignancy [51].…”

Section: Differential Diagnosismentioning

confidence: 65%

Pulmonary Histoplasmosis in a patient with Cough, Dyspnea, Pulmonary Nodule and Rheumatologic Manifestations: Case Report and Review

Britto¹

2018

JRI

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Histoplasmosis has worldwide distribution, occurring most commonly in North, Central, and South America, as well as parts of Africa and Asia [1, 2]. Histoplasmosis is a granulomatous disease caused by a dimorphic fungus Histoplasma capsulatum (H. capsulatum). There are two varieties of H. capsulatum that are pathogenic to humans, H. capsulatum var. capsulatum and H. capsulatum var. duboisii. H. capsulatum var. capsulatum is endemic in eastern United States and Latin America [3], and H. capsulatum var. duboisii is prevalent in Africa and South East Asia [4]. In the United States, H. capsulatum is primarily seen in Mississippi and Ohio River valleys. H. capsulatum grows best in soil contaminated with bird or bat droppings [5]. Transmission occurs via inhalation of H. capsulatum spores from the soil. Sites commonly associated with exposure to H. capsulatum include old buildings, caves, bridges, where birds have roosted [6, 7]. Infection may be acquired from exposure to outdoor activities such as exploring caves, construction, remodeling, demolition, bird handling, all of which can cause inhalation of the pathogen through the contaminated soil [8, 9]. The variation in clinical course due to histoplasmosis depends on the extent of the exposure to the organism. Histoplasmosis may remain asymptomatic in most healthy individuals following low-level exposure and asymptomatic pulmonary histoplasmosis is the most common syndrome following infection [10]. Fewer than five percent of exposed individuals develop symptomatic disease after a low level exposure to H. capsulatum [11]. Symptomatic infection usually causes self-limited pulmonary illnesses, rheumatologic manifestations such as arthritis or arthralgia involving the large or small joints, dermatologic manifestations such as erythema nodosum and/or erythema multiforme or pericarditis. Exposure to heavy inoculum can cause diffuse pulmonary involvement [12]. Individuals at the extremes of age or with underlying immunosuppressive conditions can develop progressive disseminated disease. Histoplasmosis can involve every organ system during the course of dissemination [13]. Here, we describe a case of pulmonary histoplasmosis in a healthy adult female presenting with cough, dyspnea, pulmonary nodule and rheumatologic manifestations.

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Section: Differential Diagnosismentioning

confidence: 65%

Pulmonary Histoplasmosis in a patient with Cough, Dyspnea, Pulmonary Nodule and Rheumatologic Manifestations: Case Report and Review

Britto¹

2018

JRI

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“…A report by Wheat et al . suggests that histoplasmosis may trigger a chronic inflammatory disease recognized as sarcoidosis [8]. We think it is unlikely that our patient’s initial presentation 20 years prior was due to histoplasmosis because he clinically improved on steroids, but could speculate that he had an initial self-limited Histoplasma infection that led to a state of chronic inflammation similar to sarcoidosis.…”

Section: Discussionmentioning

confidence: 99%

The intricate relationship of histoplasmosis and sarcoidosis: a case report

2014

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IntroductionHistoplasmosis is an endemic mycosis with most cases of clinical illness reported in North and Central America. Rarely, patients develop progressive disseminated histoplasmosis with extrapulmonary manifestations. These infections are fatal if not appropriately treated.Case presentationWe report a case of progressive disseminated histoplasmosis presenting with fever, progressive dyspnea, and pancytopenia in a 51-year-old Caucasian man who had been treated with chronic steroids for a diagnosis of sarcoidosis made 20 years previously. His presentation was initially mistaken for sarcoidosis but, fortunately, laboratory results showed hematologic abnormalities, and the diagnosis of histoplasmosis was made by bone marrow biopsy.ConclusionsSarcoidosis reduces T cell activity, and the addition of steroids for treatment causes further immunosuppression and vulnerability for development of a disseminated infection. The diagnosis of histoplasmosis depends mainly on clinical presentation and host factors. Although there are diagnostic laboratory tests available, clinicians may need to diagnose histoplasmosis by history and physical examination alone and treat empirically, since awaiting Histoplasma-specific laboratory results would delay initiation of treatment. Primary care providers, hospitalists, and subspecialists alike should be aware of the overlap in clinical and radiological presentations of sarcoidosis and histoplasmosis, and when and how to pursue diagnostic testing for endemic mycoses, since these infections can be fatal in immunosuppressed patients without appropriate treatment.

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“…The incidence of putative occupationally caused sarcoidosis is two orders of magnitude ($2 Â 10 À4 ) less than systemic granulomatous response ($2 Â 10 À2 ) ascribed to specific etiologies-tuberculosis [Scadding, 1960], histoplasmosis [Wheat et al, 1989], neoplasia [Reich, 2006], and berylliosis [Rossman and Kreider, 2003]-on the basis of the cumulative weight of numerous persuasive reports linking these etiological candidates with sarcoidosis. This approach entails a redefinition of sarcoidosis, eliminating the diagnostic requirement of ''unknown cause.''…”

Section: Discussionmentioning

confidence: 99%

Shortfalls in imputing sarcoidosis to occupational exposures

Reich

2012

American J Industrial Med

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The cause of sarcoidosis remains elusive. Reports of elevated sarcoidosis incidence in New York City firefighters and World Trade Center disaster responders have been advanced to support a causal relationship. This inference is open to question due to methodological differences in assessing and computing sarcoidosis incidence in populations versus putative occupational exposures. The magnitude of the odds ratio (OR; ca. 1.5) of causal candidates in the ACCESS case-control study of occupational and environmental exposures is sufficiently small that it might easily be attributable to confounders. Additionally, multiplicity of comparisons, difficulty in assembling a valid control population and the potential for recall bias critically limit causal inferences. A possible explanation for etiological elusiveness and multiplicity of elevated OR is that individuals with sarcoidosis, lacking components of efficient cellular immunity, respond with systemic granulomas to a variety of ubiquitous, frequently unidentifiable environmental antigens. Epidemiological methods for the identification of sarcoidosis causal candidates are potentially misleading and are unlikely to prove useful.

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Sarcoidlike Manifestations of Histoplasmosis

Cited by 29 publications

References 30 publications

Pulmonary Histoplasmosis in a patient with Cough, Dyspnea, Pulmonary Nodule and Rheumatologic Manifestations: Case Report and Review

Pulmonary Histoplasmosis in a patient with Cough, Dyspnea, Pulmonary Nodule and Rheumatologic Manifestations: Case Report and Review

The intricate relationship of histoplasmosis and sarcoidosis: a case report

Shortfalls in imputing sarcoidosis to occupational exposures

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