title: Nondisseminated histoplasmosis of the trachea.
abstract: Histoplasma capsulatum can rarely affect the trachea. We report the case of a 68-year-old woman with rheumatoid arthritis on immunosuppressive therapy who presented with fevers, worsening shortness of breath, nonproductive cough and subjective throat hoarseness and fullness. Chest computed tomography demonstrated no tracheal findings. Bronchoscopy found mucosal irregularity, nodularity and vesicular regions in the proximal trachea extending seven centimeters distal to the vocal cords. Also seen was an edematous, exudative left vocal cord with polyps and an ulcerative lesion. Silver staining and culture and wash of the tracheal biopsy revealed Histoplasma capsulatum. She was treated with oral itraconazole then briefly on intravenous amphotericin for rising Histoplasma urinary antigen levels. She continued treatment 24 months following diagnosis with minimal dyspnea. Histoplasma tracheitis has been proposed as an indicator of disseminated infection. However, our patient did not demonstrate other organ manifestations. Histoplasma tracheitis should be considered in a differential diagnosis of tracheal lesions even in the absence of systemic involvement.
authors.affiliation: Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Nicholas
authors.identifier: http://orcid.org/0000-0002-7998-4131
authors.initials: N
authors.lastname: Bhojwani
authors.affiliation: School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Jason Brett
authors.initials: JB
authors.lastname: Hartman
authors.affiliation: Department of Pathology, Mount Carmel Health System, Columbus, OH, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Taylor
authors.affiliation: Department of Infectious Disease, Mount Carmel Health System, Columbus, OH, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Herbert
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Mount Carmel Health System, Columbus, OH, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Corriveau
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage* / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D006658:Histoplasma / Q000302:isolation & purification; D006660:Histoplasmosis / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage* / Q000627:therapeutic use; D014132:Trachea / Q000382:microbiology* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B
keywords: Histoplasma; bronchoscopy; immunosuppression; trachea