Delayed Diagnosis of Pulmonary Histoplasmosis in an Immunocompetent Young Asthmatic Female from Florida, a Non-Endemic Area for Histoplasma Capsulatum

Pulmonary histoplasmosis is caused by Histoplasma capsulatum, a dimorphic fungus. We report an unusual case of pulmonary histoplasmosis in an immunocompetent 16 year old African American female from Florida. She had history of asthma and presented with recurrent episodes of difficulty breathing and chest tightness however with no wheezing. Multiple medications including systemic steroids and hospitalizations which focused on her asthma symptoms could not improve her condition. Her family history was suggestive of sarcoidosis and lymphoma, whereas her travel history revealed trips to caves in Tennessee few years previously. Extensive workup that included chest x

rays, computerized tomography (CT) scans, spirometry, bronchoscopy with broncho alveolar lavage (BAL), lymph node biopsy, wedge biopsy of the lung, serology for histoplasma, Quantiferon gold test for tuberculosis were performed as the patient’s clinical presentation unfolded over 12 months. Additionally there were other complicating psychosocial factors such as obesity and anxiety. The wedge biopsy of the lung established the final diagnosis of pulmonary histoplasmosis. This case underscores the importance of keeping broad differential diagnoses and obtaining careful history in an asthmatic patient.


Meghana Gudala and Satyanarayan Hegde

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