Extrapulmonary thoracic disease caused by Blastomyces dermatitidis.

A case of blastomycosis is reported involving the mediastinum and compromising the plexus brachialis. The pathology, pathophysiology, and treatment of this patient and of a previously reported patient are discussed and compared with the characteristics of extrapulmonary thoracic disease caused by histoplasmosis. Because of the favorable response of these patients to prolonged antifungal therapy, blastomycosis should be considered in the differential diagnosis of invasive extrapulmonary thoracic disease.

[Bone and joint sites of African histoplasmosis (Histoplasma duboisii). Apropos of a case and review of the literature].

The authors report a case of disseminated African histoplasmosis with bone and joint involvement in a black 28-year-old citizen of the Central African Republic who presented with a 17-month history of multiple osteoarticular lesions (sternoclavicular joints, humerus, ribs), cutaneous lesions (face, scalp, thorax), and lymphadenopathy. Clinical manifestations resolved rapidly under treatment with ketoconazole (600 mg/d for 10 days then 400 mg/day for nine months). Persistent yeast cells were then found upon examination of a lymph node biopsy specimen.

Hodgkin's disease masquerading as sclerosing mediastinitis.

Cases in which fibrotic variants of Hodgkin's disease have been confused with sclerosing mediastinitis have rarely been reported. Sclerosing mediastinitis typically involves the superior/middle mediastinum and, in the United States, is most commonly due to histoplasmosis. We describe the case of a patient who came to us with fevers, a mixed anemia, and a posterior mediastinal mass that on pathologic examination appeared to be due to idiopathic sclerosing mediastinitis.

The radiographic findings of fibrosing mediastinitis.

We retrospectively reviewed the radiographic findings of fibrosing mediastinitis (FM) in 33 patients. Imaging studies included chest radiographs, computed tomographic scans, magnetic resonance imaging examinations, esophograms, ventilation perfusion scans, angiograms, and venograms. Findings include bronchial narrowing in 11 patients (33 percent), pulmonary artery obstruction/narrowing in 6 patients (18 percent), esophageal narrowing in 3 patients (9 percent), and superior vena cava obstruction/narrowing in 13 patients (39 percent).

Case report: fluconazole therapy in histoplasma mediastinal granuloma.

A 41-year-old man presented with night sweats, fever, and substernal chest pain approximately 5 months after being treated for community-acquired pneumonia. Chest radiograph revealed a mediastinal mass that was confirmed by computed tomography (CT) of the thorax. During surgery, enlarged paratracheal lymph nodes and a mass surrounding the right lower lobe bronchus and bronchus intermedius were found.

Histoplasmosis during childhood.

To define the clinical presentation of histoplasmosis among hospitalized children, we reviewed the charts of patients treated for histoplasmosis at Vanderbilt University Children's Hospital during the years 1968 through 1988. Thirty-five patients with histoplasmosis diagnosed by culture, pathologic examination, or serologic testing were identified, including 29 patients (83%) with pulmonary/mediastinal infection, 5 (14%) with disseminated disease, and 1 (3%) with primary cutaneous histoplasmosis. The most common symptoms included fever, present in 26 patients (74%), and cough, present in 20 (57%).

[Mediastinal fibrosis].

Even tough the ultimate etiologic and pathogenic mechanisms of mediastinal fibrosis are not quite established, several causes have been mentioned as the more frequent inducers, such as histoplasmosis, tuberculosis and other granulomatous diseases. Generally the diagnosis is suggested by a hilar or mediastinal mass, which is seen in thorax radiography, because 40% of patients are asymptomatic. Exeresis of fibrotic Magma is difficult because usually there is no separation with trachea neither with superior cava vein.

Identification of Histoplasma capsulatum organisms in the pleural and peritoneal effusions of a dog.

Histoplasma capsulatum organisms were identified by cytologic evaluation in the thoracic and abdominal effusions of a 5-year-old sexually intact male Cocker Spaniel that was referred because of anorexia and lethargy. Treatment with amphotericin B and ketoconazole was instituted. The dog developed respiratory arrest, a complication of the disseminated disease, and died.

Disseminated histoplasmosis in chronic mucocutaneous candidiasis.

Chronic mucocutaneous candidiasis (CMC) is rarely associated with disseminated Candida, but is often associated with systemic infection secondary to other organisms [1]. A 6-year-old with CMC and disseminated histoplasmosis is presented here.

Clinical manifestation of mediastinal fibrosis and histoplasmosis.

We treated 20 patients thought to have mediastinal fibrosis secondary to Histoplasma capsulatum. All but 1 were symptomatic. The most common symptoms were dyspnea (8), hemoptysis (6), postobstructive pneumonia (5), and superior vena caval obstruction (2).

Fatal disseminated Conidiobolus coronatus infection in a renal transplant patient.

A case of fatal disseminated fungal infection due to Conidiobolus coronatus in a patient with a renal transplant is described. This organism, known to cause localized infections in otherwise healthy individuals in the tropics, is now recognized as a cause of fatal infection in immunosuppressed hosts. Histologically, localized infections are characterized by lack of vessel invasion and the presence of an eosinophilic sleeve around fungal elements, called the Splendore-Hoeppli phenomenon.

Chronic fibrosing mediastinitis and superior vena caval obstruction from blastomycosis.

Chronic fibrosing mediastinitis is most commonly a complication of granulomatous disease caused by histoplasmosis. We report a case of Blastomyces dermatitidis causing superior vena caval obstruction from fibrosing mediastinitis.

Thoracic histoplasmosis.

Histoplasmosis is a fungal disease that is seen throughout the world. It is the most common systemic fungal infection in North America, and it is endemic in the Mississippi, Ohio, and St Lawrence River valleys. Its radiographic and clinical spectrum ranges from a totally self-limited disease with minimal or no radiographic findings to a rapidly progressive, disseminated, and sometimes fatal disease.

Imaging of pediatric mediastinal histoplasmosis.

Histoplasmosis can present a diagnostic dilemma if unusually large masses of lymph nodes, invasive mediastinal fibrosis, or pericarditis result from the infection. These rare, late sequelae are often first suspected from findings on chest radiographs obtained for unrelated reasons. Organisms are not always evident at histologic analysis at this stage.

Sclerosing mediastinitis: improved management with histoplasmosis titer and ketoconazole.

Recognition that many patients with benign sclerosing mediastinitis have smoldering disease responsible for failure of surgical procedures or for development of collateral circulation in patients with superior vena caval obstruction has markedly improved management of these difficult patients. Histoplasmosis complement fixation titers have been used to detect unsuspected subacute disease and to follow the therapeutic adjunctive management with ketoconazole, an oral antifungal agent. Twenty-two patients with benign sclerosing mediastinitis demonstrated a variety of symptoms relating to the area of compression: superior vena cava, 13; esophagus, 3; pulmonary artery and pericardium, 3; and trachea, 3.

Surgical implications of sclerosing mediastinitis. A report of six cases and review of the literature.

Sclerosing mediastinitis is an uncommon disease associated with a multiplicity of clinical syndromes. The cause of this disorder is probably an abnormal fibroproliferative response to an inflammatory stimulus, most commonly a granulomatous infection secondary to Histoplasma capsulatum. The pathophysiology of this disease is predicated on the encasement of mediastinal vital organ structures within a dense fibrotic mass.

Diagnosis and treatment of pulmonary histoplasmosis in a horse.

A 2-year-old Trakehner filly with pulmonary histoplasmosis is presented. Clinical signs included weight loss, intermittent fever, dyspnea and depression. Diagnosis was based on thoracic radiography, transtracheal wash cytology and lung aspirate cytology.

Bronchoalveolar lavage fluid angiotensin-converting enzyme in interstitial lung diseases.

In this study we evaluated the disease specificity of bronchoalveolar lavage fluid angiotensin-converting enzyme (BALF-ACE), its correlation with cellular constituents of bronchoalveolar lavage fluid (BALF), and for sarcoidosis, with other proposed markers of disease activity. Furthermore, the question of the clinical value of BALF-ACE determinations in in interstitial lung diseases or any of its subgroups was addressed. The study population consisted of 222 patients, 69 with biopsy proven sarcoidosis, 3 with hypersensitivity pneumonitis, 4 with acute histoplasmosis, 27 with idiopathic pulmonary fibrosis (IPF), 4 with rheumatoid arthritis-related interstitial fibrosis, 9 with pulmonary drug toxicity, 16 with pulmonary malignancies, 26 with other parenchymal lung disease entities, and 30 in whom the final diagnosis remained indeterminate.

Bronchoscopy in the diagnosis of pulmonary histoplasmosis.

Although histoplasmosis is the most common fungal infection of the lungs in the United States, there are no reports evaluating the efficacy of fiberoptic bronchoscopy in the diagnosis of this disease. We reviewed all cases of histoplasmosis diagnosed at our institution from 1972 to 1987. Of 469 patients, 71 underwent fiberoptic bronchoscopy and had culture/histologic proof of histoplasmosis established by fiberoptic bronchoscopy or other means.