Pasqualotto Alessandro C, Damasceno Lisandra S, Leitao Terezinha M J S, Soares Renata B A, Godoy Cassia S M, Melo Marineide, Schutz Felipe, Hochhegger Bruno
Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil.
Santa Casa de Porto Alegre, Porto Alegre, Brazil.
Mycoses. 2025 Mar;68(3):e70046. doi: 10.1111/myc.70046.
Disseminated histoplasmosis is a severe and often fatal opportunistic infection, particularly among individuals with advanced HIV disease (AHD). Despite its significance, diagnosis is often delayed due to nonspecific clinical and imaging findings, as well as the limitations of classical diagnostic methods.
This study aimed to evaluate the chest computed tomography (CT) findings in patients with disseminated histoplasmosis and AHD to provide insights into the radiological patterns associated with this condition.
PATIENTS/METHODS: A total of 38 patients from a phase II clinical trial on liposomal amphotericin B were included based on the availability of high-resolution chest CT scans. Images were analysed by two radiologists, focusing on lung abnormalities such as nodules, ground-glass attenuation and lymphadenopathy. Clinical presentations, co-infections and other systemic findings were also documented.
The patients were predominantly male (78.9%) with a median age of 37.8 years. Severe immunosuppression was noted, with a median CD4 count of 22 cells/mm. Pulmonary symptoms were present in 65.8% of patients, while 73.7% reported significant weight loss. All patients had abnormal chest CT findings, with small miliary nodules (89.5%) and ground-glass attenuation (86.8%) being the most common. Large nodules were seen in 73.8% and cavitated nodules in 26.3%. Mediastinal lymphadenopathy was observed in 84.2% of cases, and pleural effusions in 23.7%. Co-infections were detected in 36.8% of the patients.
Chest CT findings in disseminated histoplasmosis are variable and often nonspecific, complicating diagnosis. The presence of diffuse micronodular patterns should raise suspicion for histoplasmosis in endemic regions, particularly among immunocompromised individuals.
播散性组织胞浆菌病是一种严重且常致命的机会性感染，在晚期HIV疾病（AHD）患者中尤为常见。尽管其具有重要性，但由于非特异性的临床和影像学表现以及传统诊断方法的局限性，诊断往往会延迟。
本研究旨在评估播散性组织胞浆菌病和AHD患者的胸部计算机断层扫描（CT）表现，以深入了解与此病相关的放射学模式。
患者/方法：基于高分辨率胸部CT扫描的可用性，纳入了一项关于脂质体两性霉素B的II期临床试验中的38例患者。两名放射科医生对图像进行分析，重点关注肺部异常，如结节、磨玻璃影和淋巴结病。还记录了临床表现、合并感染和其他全身表现。
患者以男性为主（78.9%），中位年龄为37.8岁。观察到严重免疫抑制，中位CD4细胞计数为22个/mm。65.8%的患者有肺部症状，而73.7%的患者报告有明显体重减轻。所有患者胸部CT均有异常表现，其中小结节（89.5%）和磨玻璃影（86.8%）最为常见。73.8%的患者可见大结节，26.3%的患者可见空洞性结节。84.2%的病例观察到纵隔淋巴结肿大，23.7%的病例观察到胸腔积液。36.8%的患者检测到合并感染。
播散性组织胞浆菌病的胸部CT表现多样且往往不具特异性，使诊断复杂化。在流行地区，尤其是免疫功能低下的个体中，弥漫性微结节模式的出现应引起对组织胞浆菌病的怀疑。
