Cardiovascular Manifestations and Interventions in Children Living in a Histoplasmosis Endemic Region

Histoplasmosis in children remains understudied, drawing most clinical understanding from adult populations. Located in a histoplasmosis-hyperendemic region, our institution aimed to characterize the cardiovascular manifestations and interventional treatments in children diagnosed with histoplasmosis. We conducted a retrospective cohort study of 160 patients under 18 years of age diagnosed with histoplasmosis between January 2009 and March 2023 at a tertiary-care children's hospital. Data reviewed included clinical presentation, imaging, electrocardiograms, echocardiograms, and catheter-based or surgical interventions. Of the 160 patients, 65 (41%) demonstrated cardiovascular involvement from mediastinal manifestations of histoplasmosis (mediastinal lymphadenopathy, mediastinal granuloma, and fibrosing mediastinitis) including all 8 patients with fibrosing mediastinitis. Among these 65 children, pericarditis with pericardial effusion was the most common (58%), 30 patients requiring urgent intervention. Other manifestations from mass effect included pulmonary artery stenosis (34%), superior vena cava (SVC) stenosis (15%), pulmonary vein stenosis (8%), inferior vena cava (IVC) stenosis (3%), and aortic arch obstruction (2%). Fourteen patients underwent catheter-based stenting procedures with a total of 22 stents placed (17 in pulmonary artery branches, 4 in pulmonary veins, and 1 in the SVC), typically not performed during the initial presentation. Five patients underwent mass resection for cardiac indications. Cardiovascular complications from histoplasmosis-related mediastinal lymphadenopathy in children are significant, presenting with pericarditis or compression of central vascular structures. Fibrosing mediastinitis was consistently associated with cardiac involvement, frequently necessitating intervention. Surgical repair is challenging due to extensive fibrosis. However, percutaneous vascular interventions are feasible and effective in managing vascular obstructions. Early recognition and timely intervention are critical to prevent irreversible vascular atresia.