Disseminated histoplasmosis presenting as a unilateral cranial nerve VIII mass: a case report.

OBJECTIVE

To report a unique presentation of disseminated histoplasmosis.

STUDY DESIGN

Case report.

SETTING

University hospital, tertiary referral center.

PATIENT

Our patient presented with vertigo, tinnitus, and unilateral hearing loss, and was initially found to have a 5-mm enhancing left internal auditory canal mass, as revealed by a magnetic resonance imaging (MRI) scan. Subsequently, the patient developed multiple focal neurologic deficits.

INTERVENTIONS

Magnetic resonance imaging and treatment with intravenously administered amphotericin B, with subsequent oral administration of itraconazole.

MAIN OUTCOME MEASURES

Clinical presentation and imaging findings of Histoplasmosis involving the cranial nerve VIII.

RESULTS

A subsequent MRI scan revealed enlargement of the initial lesion and multiple parenchymal lesions. Further workup revealed a pulmonary lesion; the diagnosis of disseminated histoplasmosis was made on the basis of bronchoalveolar lavage culture.

CONCLUSION

Infectious processes, including disseminated histoplasmosis, should be considered in the differential of internal auditory canal masses, especially in the setting of rapid progression of symptoms.