title: [American histoplasmosis: clinicopathological features in immunocompetent and immunocompromised patients. A report of two cases of infection by Histoplasma capsulatum on Reunion Island].
abstract: BACKGROUND
  Histoplasmosis is a fungal infection caused by Histoplasma capsulatum var. capsulatum. It shows pulmonary or multivisceral involvement. Infective spores are inhaled from soils that contain bat or bird guano. The clinical picture depends on the intensity of the exposure and the immune status of the host.
  
  
  METHODS
  We report two cases of histoplasmosis that reflect its variability in clinical and histopathological expression: a pseudo-tumoral nodular form or histoplasmoma in a pauci-symptomatic immunocompetent patient and a disseminated form with severe respiratory and mucocutaneous involvement in an immunocompromised patient. The histoplasmoma presented as a spiculated, hypermetabolic, solitary pulmonary nodule. Histopathological examination showed well-formed epithelioid granulomas with caseous central necrosis containing numerous histoplasma yeasts. In the patient with disseminated infection, the diagnosis was confirmed by seeing yeast forms in bronchoalveolar lavage fluid and skin biopsy.
  
  
  CONCLUSIONS
  These patients are the second and third cases of histoplasmosis reported on Reunion Island. Both had traveled in endemic areas several years previously. The most likely pathophysiological mechanism is the reactivation of an old latent infection. There is, therefore, no argument at present in favor of the presence of contaminated soils on Reunion Island.
authors.affiliation: Service d'anatomie pathologique, CHU Félix-Guyon, route de Bellepierre, allée des Topazes, 97405 Saint-Denis cedex 05, Réunion. Electronic address: carla.fernandez@chu-reunion.fr.
authors.forename: C
authors.initials: C
authors.lastname: Fernandez
authors.affiliation: Service de pneumologie, CHU Félix-Guyon, 97405 Saint-Denis, Réunion.
authors.forename: V
authors.initials: V
authors.lastname: Gazaille
authors.affiliation: Service d'anatomie pathologique, CHU Félix-Guyon, route de Bellepierre, allée des Topazes, 97405 Saint-Denis cedex 05, Réunion.
authors.forename: A
authors.initials: A
authors.lastname: Werbrouck-Chiraux
authors.affiliation: Laboratoire de biologie, CHU Félix-Guyon, 97405 Saint-Denis, Réunion.
authors.forename: O
authors.initials: O
authors.lastname: Belmonte
authors.affiliation: Service de médecine interne, CHU Félix-Guyon, 97405 Saint-Denis, Réunion.
authors.forename: N
authors.initials: N
authors.lastname: Sultan-Bichat
authors.affiliation: Service d'hématologie-oncologie, CHU Félix-Guyon, 97405 Saint-Denis, Réunion.
authors.forename: P
authors.initials: P
authors.lastname: Agape
authors.affiliation: Histopathologie humaine et modèles animaux, Institut Pasteur, 75724 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Chretien
authors.affiliation: Service de pneumologie, CHU Félix-Guyon, 97405 Saint-Denis, Réunion.
authors.forename: P
authors.initials: P
authors.lastname: Schlossmacher
mesh_terms: D006658:Histoplasma / Q000276:immunology; D006660:Histoplasmosis / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D007121:Immunocompetence; D016867:Immunocompromised Host; D008172:Lung Diseases, Fungal / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D017508:Reunion; D014195:Travel
keywords: Granuloma; Granulome; Histoplasma capsulatum; Histoplasmose; Histoplasmosis; La Réunion; Lung; Poumon; Reunion Island