Chronic pulmonary histoplasmosis in a Peruvian jungle hospital
DOI:
https://doi.org/10.51252/rsayb.v4i2.972Keywords:
immunosuppression, itraconazole, pulmonary mycosisAbstract
Introduction: Chronic pulmonary histoplasmosis is an uncommon form of presentation in immunocompromised patients, where the disseminated form predominates. Objective: To report an atypical case of localized chronic pulmonary histoplasmosis with endobronchial involvement in an immunosuppressed patient. Case description: A 52-year-old woman with autoimmune hemolytic anemia on immunosuppressive therapy presented with cough, hoarseness, hemoptysis, and weight loss for three months. Bronchoscopy revealed a granulomatous lesion in the trachea; microbiological tests were negative. A biopsy showed granulomatous inflammation with Histoplasma capsulatum, confirming chronic localized pulmonary histoplasmosis. Conclusions: This is an atypical, endobronchial, localized presentation in an immunosuppressed patient. The low sensitivity of microbiological studies in chronic forms and the importance of histopathological examination are noteworthy. The patient improved with oral itraconazole. This case reinforces the need to consider endemic mycoses in chronic respiratory symptoms and employ a comprehensive diagnostic approach.
The case is unusual because, despite her immunosuppressed condition, the patient did not develop disseminated histoplasmosis, but a localized form, uncommon in this risk group. In addition, endobronchial involvement with tracheal involvement is an atypical manifestation rarely documented in the literature. The diagnosis was reached by histopathological findings, highlighting the low sensitivity of conventional microbiological methods in localized chronic forms. The patient evolved favorably with oral treatment with itraconazole for six weeks, without requiring intravenous or prolonged antifungal therapy.
This case highlights the importance of considering endemic fungal infections in the differential diagnosis of chronic respiratory conditions in immunocompromised patients, as well as the need for a comprehensive diagnostic approach in the presence of negative microbiological results.
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Copyright (c) 2025 María de los Ángeles Llamo-Barboza, Sergio Leonel Carpio-Cárdenas, Pedro Vargas-Rodriguez, Jessy Gonzales-Pérez
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