It is known that Histoplasma capsulatum can cause chronic granulomatous disease or fibrosing mediastinitis, but both presentations occurring in the same patient is exceedingly rare and difficult to diagnose. The patient is a 24-year-old female with a past medical history of asthma, who presented for worsening shortness of breath. Thoracic imaging revealed a large paratracheal mass with a significant mass effect. Endobronchial ultrasound (EBUS) was attempted unsuccessfully, and the patient underwent video-assisted thoracoscopic surgery, which established the diagnosis of fibrosing mediastinitis. Extensive infectious disease workup confirmed Histoplasma infection. She was treated with a course of Itraconazole, pulmonary artery stenting, and rituximab.
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| http://dx.doi.org/10.7759/cureus.70398 | DOI Listing |
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