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.
Similar content being viewed by others
References
Kahi CJ, Wheat LJ, Allen SD, Sarosi GA. Gastrointestinal histoplasmosis. Am J Gastroenterol. 2005;100(1):220–31.
Coss KC, Wheat LJ, Conces DJ, Brashear RE, Hull MT. Esophageal fistula complicating mediastinal histoplasmosis. Am J Med. 1987;83:343–6.
Gilliland MD, Scott LD, Walker WE. Esophageal obstruction caused by mediastinal histoplasmosis: beneficial results of operation. Surgery. 1984;95(1):59–62.
Moore T. Esophageal obstruction due to mediastinal granuloma. J Thorac Surg. 1959;37:127.
Christodoupoulos J, Klotz A. Esophageal obstruction due to granulomatous mediastinal lymphadenopathy. Gastroenterology. 1961;40:574.
Marshall JB, Singh R, Demmy TL, Bickel JT, Everett ED. Mediastinal histoplasmosis presenting with esophageal involvement and dysphagia: case study. Dysphagia. 1995; Winter; 10(1):53–8.
Sarosi G, Davies SF. Gastrointestinal involvement in histoplasmosis. Pract Gastroenterol. 1984;VIII:19–31.
Savides TJ, Gress FG, Wheat LJ, Ikenberry S, Hawes RH. Dysphagia due to mediastinal granulomas: diagnosis with endoscopic ultrasonography. Gastroenterology. 1995;109(2):366–73.
Felson B, Klatte EC. Complications of the arrested primary histoplasmic complex. JAMA. 1976;236(10):1157–61.
Garamella J, Stltzman F, Varco R, Jensen N. Subcarinal mediastinal granulomas causing esophageal obstruction. J Thorac Surg. 1955;30:187.
Wheat J, French ML, Kohler RB, et al. Laboratory tests for histoplasmosis: analysis of experience in a large urban outbreak. Ann Intern Med. 1982;(97) 5:680–5.
Fifer W, Woellner R, Gordon S. Mediastinal Histoplasmosis. Report of three cases with dysphagia as the presenting complaint. Chest. 1965;(47) 5: 518–6.
Ray A, Gahunia M. Histoplasmosis presenting as a hypopharyngeal mass in an immune compromised host. Pract Gastroenterol; 2010 pp. 41–6.
Wheat J, Sarosi G, Mckinsey D, et al. Practice guidelines for management of patients with histoplasmosis. Infectious diseases society of America. Clin Infect Dis. 2000;30(4):688–95.
Acknowledgments
We thank Dr. Kimberly Helms for providing the H&E-stained slide of lymph node biopsy.
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chaudhari, D., Mckinney, J., Hubbs, D. et al. Mediastinal histoplasmosis presenting as dysphagia: a case report with literature review. Clin J Gastroenterol 6, 315–318 (2013). https://doi.org/10.1007/s12328-013-0405-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12328-013-0405-y