Disseminated Histoplasmosis: An Unusual Finding at ROSE

Area of Science:

• Medical Diagnostics
• Infectious Diseases
• Pulmonology

Background:

• Disseminated histoplasmosis is a serious fungal infection, particularly in immunocompromised individuals.
• Renal transplant recipients are at increased risk due to immunosuppression.
• Early diagnosis is crucial for effective management and improved patient outcomes.

Purpose of the Study:

• To report an unusual case of disseminated histoplasmosis.
• To highlight the utility of rapid on-site assessment (ROSE) during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for suspected disseminated histoplasmosis.
• To emphasize the role of cytomorphologic findings in early diagnosis.

Main Methods:

• A case study of a renal transplant recipient presenting with relevant symptoms.
• Performance of EBUS-TBNA targeting mediastinal lymph nodes (stations 11L and 7).
• Intraprocedural ROSE for immediate cytomorphologic evaluation.

Main Results:

• ROSE suggested disseminated histoplasmosis during the EBUS-TBNA procedure.
• Subsequent microbiologic cultures confirmed the diagnosis of disseminated histoplasmosis.
• Cytomorphologic features on routine stains were indicative of the fungal infection.

Conclusions:

• ROSE during EBUS-TBNA can provide timely diagnostic suspicion for disseminated histoplasmosis.
• Cytomorphology on routine stains is a valuable tool for identifying disseminated histoplasmosis.
• Prompt diagnosis and treatment are essential for managing this opportunistic infection in transplant patients.