Albandak Maram, Azar Jehad, Ayyad Mohammed, Salah Qais, Toqan Anas, Giacaman Narmeen, Marzouqa Nizar, Al-Tawil Mohammed, Wishah Bisan, Barabrah Anas
Internal Medicine, Al-Quds University, Jerusalem, PSE.
Respiratory Institute, Cleveland Clinic, Cleveland, USA.
Cureus. 2023 Apr 4;15(4):e37095. doi: 10.7759/cureus.37095. eCollection 2023 Apr.
is a fungal organism that causes systemic histoplasmosis. It is commonly asymptomatic in healthy immunocompetent individuals. The clinical symptoms of chronic cavitary histoplasmosis are typically seen in the immunodeficient population, particularly in smokers with pre-existing structural lung disease. We report a case of chronic cavitary histoplasmosis in an immunocompetent patient from an endemic area without pre-existing structural lung pathology. She presented complaining of right hypochondrial pain and had no history of respiratory symptoms nor history suggestive of immunosuppression, tuberculosis, or recent travel. CT scan revealed a cavitary lung lesion and a hilar mediastinal mass. Biopsies obtained by bronchoscopy revealed signs of necrosis, granulomas, and the presence of fungal organisms consistent with histoplasmosis. antibodies by complement fixation for yeast antibodies test were positive establishing the diagnosis of chronic cavitary pulmonary histoplasmosis (CCPH). She was then started on itraconazole with good tolerance. On follow-up three months later, a chest CT done along with measurement of inflammatory markers and liver enzymes demonstrated complete clinical recovery. This case emphasizes the importance of expanding our current understanding of the clinical presentation and manifestations of histoplasmosis beyond the conventional assumption that severe disease only affects immunocompromised individuals.
是一种可引起系统性组织胞浆菌病的真菌生物体。在健康的免疫功能正常个体中通常无症状。慢性空洞性组织胞浆菌病的临床症状通常见于免疫缺陷人群，尤其是患有既往结构性肺病的吸烟者。我们报告一例来自地方病区的免疫功能正常患者的慢性空洞性组织胞浆菌病病例，该患者无既往结构性肺部病变。她因右季肋部疼痛就诊，无呼吸道症状病史，也无提示免疫抑制、结核病或近期旅行的病史。CT扫描显示肺部有空洞性病变和肺门纵隔肿块。通过支气管镜检查获取的活检显示有坏死、肉芽肿迹象以及与组织胞浆菌病相符的真菌生物体存在。补体结合法检测酵母抗体呈阳性，确立了慢性空洞性肺组织胞浆菌病（CCPH）的诊断。随后她开始服用伊曲康唑，耐受性良好。三个月后的随访中，进行了胸部CT检查并检测了炎症标志物和肝酶，结果显示临床完全康复。该病例强调了扩大我们目前对组织胞浆菌病临床表现的理解的重要性，超越了严重疾病仅影响免疫受损个体的传统假设。
