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Clinical Note |

A Case Series and Review of Histoplasmosis Infection in the Neck

Jennifer A. Johnson, MD; James E. Loyd, MD; L. Joseph Wheat, MD; James L. Netterville, MD
Arch Otolaryngol Head Neck Surg. 2010;136(9):916-919. doi:10.1001/archoto.2010.143.
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An endemic fungus of the Ohio and Mississippi River valleys, Histoplasma capsulatum is found in soil contaminated with bird or bat droppings. Inhalation of H capsulatum spores leads to infection, which can either be asymptomatic, present as an acute influenzalike illness, or progress to disseminated life-threatening disease. Although most cases of pulmonary histoplasmosis are associated with hilar or mediastinal lymphadentis confined within the thorax, clinical presentation in the neck has been reported. Complications from histoplasmosis are caused by inflammation of pulmonary or regional lymph nodes. One specific complication of inflammation from histoplasmosis is the development of a mediastinal granuloma, characterized by a mediastinal mass (3-10 cm) comprised mostly of caseous mediastinal lymph nodes that have matted together and broken down into a single semiliquid encapsulated lesion.1 Mediastinal granulomas are often located in the right paratracheal region and less frequently in the left paratracheal, subcarinal, or hilar regions. They are usually asymptomatic and are often discovered incidentally on chest radiography. Rarely, mediastinal granulomas produce symptoms related to superior vena cava or esophageal compression or from fistula formation to esophagus, bronchus, or skin.1 We describe 4 patients with cervical manifestations of histoplasmosis, review existing literature, and provide suggestions for diagnosis and treatment of this unusual disease presentation. This study was approved by the institutional review board of Vanderbilt University, Nashville, Tennessee.

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Figure 1.

Neck mass in a 15-year-old girl (patient 1).

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Figure 2.

T2 axial magnetic resonance image demonstrating a multicystic neck mass.

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Figure 3.

Hematoxylin-eosin–stained section of neck tissue demonstrating necrotizing granulomatous inflammation (original magnification ×200).

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