Histoplasmosis: A Rare Cause of Cervical Lymphadenopathy

Over the past few years, there has been a significant rise in the prevalence of human fungal infections worldwide, largely due to factors such as the acquired immunodeficiency syndrome (AIDS) pandemic, widespread use of antibacterial agents, and the utilization of chemotherapeutic agents for treating neoplastic diseases. Histoplasmosis, attributed to the dimorphic fungus Histoplasma capsulatum, is one such opportunistic fungal infection. It is endemic to regions along the "Ohio" and "Mississippi" river valleys and is frequently located in soil tainted by bat or bird feces. Cases occurring outside these endemic areas are often due to imported diseases. Histoplasmosis is not considered endemic in India, but regions with high prevalence have been reported in the Gangetic plain, particularly in West Bengal and Uttar Pradesh. The prevalence of histoplasmosis in India, as determined by histoplasmin skin sensitivity testing, ranges from 0 to 12.3%. Infection typically occurs through inhalation of spores, with the majority of cases being asymptomatic or presenting with minimal symptoms in over 99% of patients. Symptomatic cases usually manifest as acute pulmonary histoplasmosis, which is a self-limiting illness resembling atypical pneumonia. However, immunocompromised individuals, particularly those with impaired T-cell immunity, may fail to elicit appropriate immunological responses, leading to the development of disseminated histoplasmosis. This form of infection can manifest with symptoms such as anorexia, pancytopenia, fever, weight loss, hepatosplenomegaly, as well as mucosal ulceration. Histoplasmosis resulting in isolated lymphadenopathy is uncommon, especially in India, where tuberculosis constitutes the primary etiology in the majority of instances. Diverse and ambiguous symptoms of histoplasmosis often lead to misdiagnosis or underreporting of infections. Thus, it is essential to include histoplasmosis in the list of potential causes for cervical lymphadenopathy, especially among immunocompromised individuals. Early medical intervention is essential to prevent dissemination of the disease. The presentation of histoplasmosis with cervical lymphadenopathy is uncommon, and we present a case of such occurrence here.