Yonsei Med J.  2015 May;56(3):871-874. 10.3349/ymj.2015.56.3.871.

Chronic Cavitary Pulmonary Histoplasmosis in a Non-HIV and Immunocompromised Patient without Overseas Travel History

• Jung EJ
• Park DW
• Choi JW
• Choi WS

• KMID: 2450367
• DOI: http://doi.org/10.3349/ymj.2015.56.3.871

Abstract

Korea is not known as an endemic area for Histoplasma. However, we experienced a case of histoplasmosis in a person who had never been abroad. A 65-year-old female was admitted to the hospital for evaluation of multiple lung nodules. A computed tomography (CT) scan of the chest showed multiple ill-defined consolidations and cavitations in all lobes of both lungs. The patient underwent a CT-guided lung biopsy, and a histopathology study showed findings compatible with histoplasmosis. Based on biopsy results and clinical findings, the patient was diagnosed with chronic cavitary pulmonary histoplasmosis. The patient recovered completely following itraconazole treatment. This is the first case report of pulmonary histoplasmosis unconnected with either HIV infection or endemicity in Korea.

Keyword

Histoplasma capsulatum; immunocompromised host; Korea

MeSH Terms

Aged
Antifungal Agents/therapeutic use
Biopsy
Female
Histoplasma/*isolation & purification
Histoplasmosis/*diagnosis/drug therapy/microbiology
Humans
*Immunocompromised Host
Itraconazole/therapeutic use
Lung Diseases, Fungal/*diagnosis/drug therapy
Republic of Korea
Tomography, X-Ray Computed
Treatment Outcome
Antifungal Agents
Itraconazole

Figure

• 

  Fig. 1 Chest X-ray images. (A) A chest X-ray taken 6 months before a diagnosis. (B) A chest X-ray taken before the start of treatment shows multiple nodules in both lungs. (C) A chest X-ray taken 12-month after treatment shows complete resolution of the nodules.

• 

  Fig. 2 Chest contrast-enhanced computed tomography (CT) scan images. (A) The chest CT scan shows well-defined multiple nodules of various sizes in both lung fields. (B) Some nodules have low internal attenuation or cavitation.

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  Fig. 3 Histopathologic examination of the lung. (A) Hematoxylin and eosin stain (×400). (B) Periodic acid-Schiff stain (×1000). (C) Gomori Methenamine Silver (GMS) stain (×1000). (D) Many budding yeast-form fungal microorganisms are observed in the cytoplasm of alveolar macrophages, which are clearly identified by the GMS stain (×1000).

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