Case records of the Massachusetts General Hospital. Case 32-2014. A 78-year-old woman with chronic sore throat and a tonsillar mass

Metagenomic next-generation sequencing identified Histoplasma capsulatum in the lung and epiglottis of a Chinese patient: A case report

Histoplasmosis is an endemic disease mainly occurring in North America and is rare in China. Confirmation of histoplasmosis should be based on a compatible clinical scenario and a positive culture or histopathology. However, there are still many cases that are misdiagnosed or missed, especially in individuals from non-endemic areas. In recent years, metagenomic next-generation sequencing (mNGS) has led to the accurate and timely diagnosis of some rare and complicated infectious diseases. We describe the case of a 27-year-old Chinese man who had chronic progressive pulmonary lesions without any symptoms for more than 1year, until the lesions reached the epiglottis and led to progressive pharyngeal pain. There were no positive results from bronchoalveolar lavage fluid (BALF) and epiglottis tissue cultures, or from epiglottis and lung pathological examinations, but mNGS was able to identify Histoplasma capsulatum in the epiglottis tissues and BALF as the cause of the lesions. The patient was treated successfully with itraconazole.

Immune reconstitution inflammatory syndrome associated with disseminated histoplasmosis and TNF-alpha inhibition

Endemic fungal infections are a significant problem for patients on TNF-alpha inhibitors. Immune reconstitution inflammatory syndrome, IRIS, can present in patients with waning TNF-alpha inhibition and an endemic fungal infection. There may be a potential role that TNF-alpha inhibitors can play in mitigating IRIS related to disseminated endemic fungal infections.

Case Report: Histoplasmosis: First Autochthonous Case from Israel

We present an autochthonous Histoplasma infection in Israel. The patient presented with hoarseness and weight loss. Pathology findings and molecular tests confirmed the diagnosis, and the patient responded to antifungal therapy. Because the patient had an atypical presentation of histoplasmosis, it is likely that other more typical cases have gone unreported. To our knowledge, no other cases have been previously reported from Israel or the Middle East region.

A necrotic tonsillar lesion: An unusual presentation of disseminated histoplasmosis

We report a case of tonsillar histoplasmosis with hematogenous dissemination in a woman receiving infliximab for Crohn's disease. She also had a history of sarcoidosis. Due to the unusual location and confounding medical history, our case provided a diagnostic dilemma. Histoplasma infection was confirmed histologically, and the patient responded well to appropriate treatment.