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H. capsulatum: A Not-So-Benign Cause of Pericarditis

Paolo K Soriano1, Muhammad Iqbal1, Shakthishri Kandaswamy1

  • 1Department of Internal Medicine, Southern Illinois University, 751 N Rutledge, Springfield, IL 62702, USA.

Case Reports in Cardiology
|October 31, 2017
PubMed

Insights

Pericarditis is often benign, but unresponsive cases may indicate fungal infection. Early evaluation for histoplasmosis is crucial in patients failing standard treatments.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Pathology

Background:

  • Pericarditis is typically benign and treated empirically with NSAIDs and steroids.
  • Further diagnostic testing is often forgone due to the presumed viral etiology and favorable prognosis.

Observation:

  • A patient presented with pericarditis refractory to standard nonsteroidal anti-inflammatory drugs (NSAIDs) and steroid therapy.
  • Tissue biopsy revealed necrotizing granulomas with fungal elements, and serologic tests confirmed active *Histoplasma capsulatum* infection.

Findings:

  • The patient demonstrated a positive response to Itraconazole, an antifungal medication.
  • Necrotizing granulomas and fungal elements in pericardial tissue indicate a specific etiology.

Implications:

  • For persistent pericarditis cases unresponsive to initial treatments, a comprehensive etiological evaluation is recommended.
  • Histoplasmosis should be considered as a potential cause of pericarditis, particularly in regions where *H. capsulatum* is endemic.

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