Pharyngo-laryngeal histoplasmosis in an immunocompromised child\u2014a case report

Arunabha Chakravarti,Rohini R Nair,Anita Nangia,Piali Mandal,Jagdish Chandra,Moazzam Mojahid

doi:10.1186/s43163-021-00146-1

Arunabha Chakravarti, Rohini R Nair + Show 4 more

Open Access

https://doi.org/10.1186/s43163-021-00146-1

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Abstract

BackgroundHistoplasmosis is an endemic granulomatous fungal infection which rarely infects the larynx; less than 100 cases have been reported in medical literature till date.Case presentationA 6-year-old female child, a diagnosed case of B cell acute lymphoblastic leukemia since past 2 years and on chemotherapy, presented with hoarseness and dysphagia since past 2 months. Direct laryngoscopy revealed granular appearance of posterior pharyngeal wall and the supra-glottic larynx. Histopathological examination and bone marrow aspiration confirmed the diagnosis of disseminated histoplasmosis.ConclusionsPharyngo-laryngeal histoplasmosis should be considered in the differential diagnosis of an immunocompromised patient presenting with persistent hoarseness.

Highlights

Histoplasmosis is an endemic granulomatous fungal infection which rarely infects the larynx; less than 100 cases have been reported in medical literature till date
With the diagnosis of pharyngo-laryngeal histoplasmosis, Contrast-enhanced computed tomography (CECT) of neck, chest, abdomen, and bone marrow aspiration was done to rule out disseminated disease
Histoplasmosis is a granulomatous disease of universal distribution caused by a dimorphic intracellular fungus, histoplasma capsulatum which mainly affects the reticular system [6]

Summary

Background

Histoplasmosis is a non-contagious systemic fungal infection, caused by a thermally dimorphic fungus, Histoplasma capsulatum. Case presentation A 6-year-old female child, with diagnosed case of B cell acute lymphoblastic leukemia on chemotherapy for last 2 years, was referred to the ENT department with complaints of hoarseness of voice and dysphagia since past 2 months. It was associated with history of intermittent fever and dry cough for 1 month. The macrophages showed foamy cytoplasm, with numerous intracellular and extracellular histoplasma spores, which was positive for periodic acid Schiff stain These spores stained positive with Gomori’s methanamine-silver stain, confirming the tissue diagnosis of histoplasmosis. With the diagnosis of pharyngo-laryngeal histoplasmosis, CECT of neck, chest, abdomen, and bone marrow aspiration was done to rule out disseminated disease. Duration of oral Itraconazole was increased by 2 months and no recurrence has been seen on 2 years of follow-up

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