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Histoplasmosis mimicking primary lung cancer or pulmonary metastases
Aline Gehlen Dall Bello1, Cecilia Bittencourt Severo, Luciana Silva Guazzelli
1Mycology Laboratory, Santa Casa Sisters of Mercy Hospital of Porto Alegre, Porto Alegre, Brazil. alinegdb@ibest.com.br
Objective:
To describe the main clinical and radiological characteristics of patients with histoplasmosis mimicking lung cancer.
Methods:
This was a retrospective descriptive study based on the analysis of the medical records of the 294 patients diagnosed with histoplasmosis between 1977 and 2011 at the Mycology Laboratory of the Santa Casa Sisters of Mercy Hospital of Porto Alegre in the city of Porto Alegre, Brazil. The diagnosis of histoplasmosis was established by culture, histopathological examination, or immunodiffusion testing (identification of M or H precipitation bands). After identifying the patients with macroscopic lesions, as well as radiological and CT findings consistent with malignancy, we divided the patients into two groups: those with a history of cancer and presenting with lesions mimicking metastases (HC group); and those with no such history but also presenting with lesions mimicking metastases (NHC group).
Results:
Of the 294 patients diagnosed with histoplasmosis, 15 had presented with lesions mimicking primary neoplasia or metastases (9 and 6 in the HC and NHC groups, respectively). The age of the patients ranged from 13 to 67 years (median, 44 years). Of the 15 patients, 14 (93%) presented with pulmonary lesions at the time of hospitalization.
Conclusions:
The clinical and radiological syndrome of neoplastic disease is not confined to malignancy, and granulomatous infectious diseases must therefore be considered in the differential diagnosis.
Insights
Histoplasmosis can mimic lung cancer, presenting with similar clinical and radiological findings. This study highlights the importance of considering infectious granulomatous diseases in cancer differential diagnoses.
Area of Science:
- Medical Mycology
- Pulmonology
- Radiology
Background:
- Histoplasmosis is a fungal infection that can present with symptoms and imaging findings similar to lung cancer.
- Accurate diagnosis is crucial for appropriate treatment and patient outcomes.
Purpose of the Study:
- To characterize the clinical and radiological features of histoplasmosis that mimic lung cancer.
- To aid in the differential diagnosis of pulmonary lesions.
Main Methods:
- Retrospective analysis of 294 histoplasmosis cases diagnosed between 1977 and 2011.
- Patients with lesions mimicking malignancy were divided into those with a history of cancer (HC) and those without (NHC).
- Diagnostic methods included culture, histopathology, and immunodiffusion.
Main Results:
- 15 patients (5.1%) presented with lesions mimicking primary neoplasia or metastases.
- 14 out of 15 patients (93%) had pulmonary lesions upon hospitalization.
- The median age of affected patients was 44 years.
Conclusions:
- The clinical and radiological presentation of neoplastic disease is not exclusive to malignancy.
- Granulomatous infectious diseases, such as histoplasmosis, should be considered in the differential diagnosis of suspected lung cancer.
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