Chronic pulmonary histoplasmosis masquerading as tuberculoma: A case report and literature review

In endemic areas of Southeast Asia, particularly Indonesia, histoplasmosis is one of the most common causes of fungal respiratory infections. It can manifest in a variety of ways and has a wide range of clinical symptoms.

A 25-year-old woman who worked as a farmer and lived in a cold, humid region presented with chronic pleuritic chest pain and was diagnosed with pulmonary tuberculosis. She was treated with anti-tuberculosis drugs for 2 months, but there was no clinical or radiological improvement. Chest x-ray revealed tuberculoma. Based on a multidisciplinary team discussion, surgery was considered. Histopathological examination revealed histoplasmic fungal spores. We determined that the patient had chronic pulmonary histoplasmosis, a clinically suggestive form of lung nodule, based on the multidisciplinary discussion. After receiving antifungal therapy, there was a noticeable improvement in both clinical and radiological outcomes.

The fungus Histoplasma capsulatum is the principal cause of chronic pulmonary histoplasmosis (CPH), a lung illness. On computed tomography (CT) imaging, histoplasmosis pulmonary nodules frequently show up with features similar to those of tuberculoma. When host variables (immunocompromising diseases), relevant clinical symptoms, and mycological evidence are present, a probable diagnosis of histoplasmosis can still be made, even though a conclusive diagnosis requires culture or histopathologic confirmation.

Due to the low sensitivity of culture, several tests might be necessary to confirm the diagnosis of chronic pulmonary histoplasmosis. Since histoplasmosis symptoms frequently resemble those of pulmonary infections like tuberculosis.