title: Mediastinal histoplasmosis presenting as dysphagia: a case report with literature review.
abstract: Histoplasmosis is an endemic infection of the Ohio and Mississippi River valleys. Clinical presentation of infection in immunocompetent hosts ranges from asymptomatic to minor flu-like symptoms; however, disseminated infection can occur in immunocompromised patients. Esophageal involvement in the form of dysphagia secondary to mediastinal histoplasmosis is rarely reported in the literature. We present a young female who complained of dysphagia and was found to have an esophageal stricture on barium esophagogram. Endoscopy revealed a submucosal nodule stricture situated 29 cm from the incisors. She underwent thoracotomy for lymph node removal. Histologic findings of the removed lymph node showed caseating granuloma with macrophages. The clinical findings together with the laboratory evaluation and biopsy features were suggestive of mediastinal histoplasmosis as the cause of the dysphagia.
authors.affiliation: Department of Internal Medicine, East Tennessee State University, 1008 Quality Circle, Apt 79, Johnson City, 37615, TN, USA. chaudharidhara@yahoo.com.
authors.forename: Dhara
authors.initials: D
authors.lastname: Chaudhari
authors.affiliation: Department of Gastroenterology, East Tennessee State University, Johnson City, TN, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Mckinney
authors.affiliation: Department of Internal Medicine, East Tennessee State University, 1008 Quality Circle, Apt 79, Johnson City, 37615, TN, USA.
authors.forename: Doris
authors.initials: D
authors.lastname: Hubbs
authors.affiliation: Department of Gastroenterology, East Tennessee State University, Johnson City, TN, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Young
keywords: Dysphagia; Histoplasma; Mediastinal histoplasmosis; Mediastinal lymphadenopathy