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Fulltext Bilateral adrenal histoplasmosis: endoscopic ultrasound-guided fine needle aspiration as a method of diagnosis and assessment

Khairul Azhar J, Jacqueline HSG, Tony LKH, Tan BH, Steven JM

Med J Malaysia, 2011 Dec;66(5):504-6.

PMID: 22390113

We report a case of a healthy 78-year-old indonesian man who presented with chronic weight loss, poor appetite and lethargy. CT abdomen showed bilateral adrenal masses. EUS-guided FNA was performed on the left adrenal gland. Histopathology report was Histoplasma Capsulatum. He recovered well with antifungal treatment without any complication. In this case, we found that the role of EUS -guided FNA was not only limited to diagnosis but also helped in the prognosis of the disease since the method was able to assess the general anatomy of the adrenal gland better than other imaging modalities due to its close proximity and direct visualization.

Matched MeSH terms: Histoplasmosis/diagnosis*; Histoplasmosis/microbiology*

Review of oral histoplasmosis in Malaysians

Ng KH, Siar CH

Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1996 Mar;81(3):303-7.

PMID: 8653464

We reviewed biopsy records for 37 cases of oral histoplasmosis for patient characteristics, clinical features, and histopathologic findings. These represented cases diagnosed in the Division of Stomatology, Institute for Medical Research, Kuala Lumpur between July 1967 and October 1994. All were male patients who ranged in age from 11 to 79 years (mean age, 56.7 years). There were 40.6% Malays, 37.8% Chinese, 18.9% Indians, and 2.7% other races. Five patients with mouth lesions as the initial presenting lesions were proven to be cases of disseminated histoplasmosis. In the remaining cases apart from the biopsy-proven oral histoplasmosis lesions, the extent of the disease elsewhere was unknown. The majority of these lesions involved the gingiva, tongue, and palate in decreasing order of frequency. The most frequent presenting symptom was oral mucosal ulceration. Squamous cell carcinoma and tuberculosis were the two most common clinical differential diagnoses. Our present findings compare favorably with published reports from other regions.

Matched MeSH terms: Histoplasmosis/epidemiology*; Histoplasmosis/pathology

Oral histoplasmosis presenting as oral ulcer in a non-HIV patient

Rahman MT, Bakar NH, Philip R, Shamsudin AR

Southeast Asian J. Trop. Med. Public Health, 2004 Jun;35(2):388-90.

PMID: 15691142

A 40-year-old man presented with chronic mouth ulcer for the last six months. Histopathological examination of the biopsy from the lesion confirmed a diagnosis of histoplasmosis. Although histoplasmosis commonly manifests in immunocompromized patients, like HIV, the present case was negative for HIV. Histoplasmosis is endemic in certain parts of the world and it is comparatively rare in the South Asian region, particularly Malaysia. Thirty-seven cases of histoplasmosis were reported from Malaysia (Ng and Siar, 1996), between July 1967 and October 1997. Despite the apparent rarity of the disease, clinicians and pathologists should be aware of the possibility of histoplasmosis when cases of oral ulcer are encountered.

Matched MeSH terms: Histoplasmosis/diagnosis*; Histoplasmosis/microbiology; Histoplasmosis/pathology

HISTOPLASMIN SENSITIVITY INVESTIGATION IN THE THIRD DIVISION OF SARAWAK, BORNEO

SCHUMAN ND, MACKEY DM, SAFRIT HF

Am. Rev. Respir. Dis., 1963 Aug;88:261-3.

PMID: 14045234

Matched MeSH terms: Histoplasmosis*

Sensitivity to tuberculin, PPD-B and histoplasmin in the population of Sabah in East Malaysia

Roy RN

Med J Aust, 1971 Feb 06;1(6):317-21.

PMID: 5546216

Matched MeSH terms: Histoplasmosis/diagnosis

Occurrence of histoplasmosis in Asia

Randhawa HS

Mycopathol Mycol Appl, 1970;41(1):75-89.

PMID: 4938836

Matched MeSH terms: Histoplasmosis/diagnosis; Histoplasmosis/epidemiology*; Histoplasmosis/veterinary

Histoplasmosis in Malaya

Ponnampalam JT

Br J Dis Chest, 1964 Apr;58:49-55.

PMID: 14152216

A survey of 227 patients from 5-60 years of age revealed the presence of positive histoplasmin skin tests in 10.5 per cent. and positive complement-fixation tests in 19-8 per cent. Sputum from 13 of the 37 patients who had a positive complement-fixation test were cultured for H. capsulatum but with negative results. Exposure to infection by the fungus is equally distributed among the different race and age groups. A careful and constant watch should be kept for histoplasmosis in all chest hospitals as a certain number of cases may be present. It tends to elude diagnosis unless specially sought as it resembles the clinical picture of tuberculosis or other granulomatous disease. It presents a field for further investigation and research in Malaya.

Matched MeSH terms: Histoplasmosis*

A review of histoplasmosis in Malaya

Ponnampalam JT

Med J Malaya, 1968 Jun;23(4):295-8.

PMID: 4235593

Matched MeSH terms: Histoplasmosis/epidemiology*

Disseminated histoplasmosis mimicking an acute appendicitis

Marsilla MM, Khairunisa AA, Azyani Y, Petrick P

Malays J Pathol, 2019 Aug;41(2):223-227.

PMID: 31427560

INTRODUCTION: Histoplasmosis can present in a myriad of clinical manifestations, which often makes its diagnosis difficult and occasionally, deceptive.

CASE REPORT: We describe a case of a 33 years old gentleman who was clinically diagnosed as acute appendicitis at initial presentation in view of a one-week history of fever, right lower quadrant abdominal pain- and guarding at right iliac fossa. He had thrombocytopenia and lymphopenia on presentation. Mesenteric lymphadenitis and small bowel lesion were found intraoperatively, which was respectively biopsied and resected. Histopathological result confirms disseminated histoplasmosis. Retroviral screen was positive. He was treated with amphotericin B for one week, subsequently switched to oral itraconazole, followed by initiation of highly active antiretroviral therapy (HAART).

DISCUSSION: This case illustrates the various nature of histoplasmosis presentation. A high index of suspicion is needed to clinch the diagnosis and subsequently institute prompt treatment as disseminated disease can be fatal if left untreated in an immunosuppressed host.

Matched MeSH terms: Histoplasmosis

Fulltext Disseminated histoplasmosis presenting as a non-healing tongue ulcer

Liam CK, Chua CT, Pathmanathan R

Singapore Med J, 1990 Jun;31(3):286-8.

PMID: 2392708

A 51-year old man presented with a persistent tongue ulcer, fever, cervical lymphadenopathy and hepatomegaly. The diagnosis was initially thought to be tuberculosis. This led to the initiation of antituberculous chemotherapy to which the patient failed to respond. The correct diagnosis of histoplasmosis was made after the detection of Histoplasma capsulatum on further review of the tongue ulcer biopsy specimen. He responded to treatment with amphotericin B.

Matched MeSH terms: Histoplasmosis/complications; Histoplasmosis/diagnosis*

THE ISOLATION OF HISTOPLASMA CAPSULATUM FROM A PATIENT IN A CHEST HOSPITAL

PONNAMPALAM JT

Med J Malaysia, 1964 Mar;18:201-4.

PMID: 14157186

Matched MeSH terms: Histoplasmosis*

Cystic tumor of papillary muscle of heart: a rare finding in sudden death

Murty OP

Am J Forensic Med Pathol, 2009 Jun;30(2):201-3.

PMID: 19465820 DOI: 10.1097/PAF.0b013e31819d9af5

Primary cystic tumors of papillary muscles of the heart are extremely rare. Here, one case of unusual cystic tumor in papillary muscle of the heart in a 37-year-old Myanmar migrant worker has been reported. He came to Malaysia 2 weeks before and one morning was found dead in sleep. Autopsy revealed cystic lesion in the papillary muscle of the mitral valve of heart, which was prolapsing into ventricular cavity. The cyst had white-jelly like sticky mucus material. The cyst was present in papillary muscle with slight invasion in septum area; it was lined by cuboidal-columnar epithelium and contained mucinous contents. There was no evidence of an inflammatory reaction in the cyst and in cardiac muscles. In addition to cystic neoplasm, the deceased also had histoplasmosis of the lungs. The case is presented with macroscopic and microscopic photographs of the cyst and histoplasmosis of the lungs. This case is reported because of its rarity, unique position, and unusual appearance.

Matched MeSH terms: Histoplasmosis/pathology

Disseminated histoplasmosis presenting with ileal perforation in a renal transplant recipient

Zainudin BM, Kassim F, Annuar NM, Lim CS, Ghazali AK, Murad Z

J Trop Med Hyg, 1992 Aug;95(4):276-9.

PMID: 1495124

A renal transplant patient presented with ileal perforation due to histoplasmosis 3 years after transplantation. Mesenteric lymph nodes and lungs were also affected by the disease. She was successfully treated with amphotericin B followed by ketoconazole.

Matched MeSH terms: Histoplasmosis/complications; Histoplasmosis/diagnosis*; Histoplasmosis/drug therapy

Fulltext A case report on biochemical aberrations in disseminated histoplasmosis: the clues toward addison’s disease

Izzatul Aliaa Badaruddin, Dian Nasriana Nasuruddin, Hanita Othman, Munirah Mansor

Malaysian Journal of Medicine and Health Sciences, 2020;16(1):348-350.

MyJurnal

The incidence of Addison’s disease (AD) is rare. One of the most common causes of AD in developed countries is autoimmune. On the other hand, in developing countries, infective causes still predominate. The symptoms are mostly insidious in onset and non-specific, making it challenging to diagnose AD. The delay in starting the right treatment predisposes to high mortality due to Addison’s crisis. Hence, biochemical parameters play a vital role in diagnosing AD since they usually will present with prominent hyponatraemia, hyperkalaemia and hypoglycaemia. Here, we report a case of a 66-year-old man with multiple co-morbidities and disseminated histoplasmosis who pre- sented with asymptomatic hyponatraemia and hyperkalaemia and was eventually diagnosed with Addison’s disease. Although the non-specific symptoms from his multiple co-morbidities obscured the diagnosis of AD, comprehensive biochemical tests have helped in establishing the diagnosis.

Matched MeSH terms: Histoplasmosis

Fulltext Laryngeal histoplasmosis: an occupational hazard

Teoh JW, Hassan F, Mohamad Yunus MR

Singapore Med J, 2013 Oct;54(10):e208-10.

PMID: 24154590

Isolated laryngeal histoplasmosis is a very rare entity. It has variable clinical presentations that might mimic both benign and malignant lesions, and is usually associated with pulmonary and other disseminated forms of histoplasmosis. Herein, we report a case of primary laryngeal histoplasmosis without the involvement of other systems in a 70-year-old Chinese man, who previously worked as a miner. He presented with a history of hoarseness for two months, with no other associated symptoms. Direct laryngoscopy revealed irregularity of the posterior one-third of both vocal folds. Histopathological examination revealed the presence of Histoplasma capsulatumon periodic acidSchiff and Grocott's methenamine silver staining. The lesion resolved after one month of oral itraconazole treatment. However, the patient had to complete six months of antifungal treatment to prevent recurrence.

Matched MeSH terms: Histoplasmosis/diagnosis; Histoplasmosis/drug therapy; Histoplasmosis/microbiology*

An outbreak of histoplasmosis among healthy young Japanese women after traveling to Southeast Asia

Ohno H, Ogata Y, Suguro H, Yokota S, Watanabe A, Kamei K, et al.

Intern. Med., 2010;49(5):491-5.

PMID: 20190491

Histoplasmosis, caused by Histoplasma capsulatum, is an endemic mycosis in many countries of the world except for Japan. Outbreaks of histoplasmosis among Japanese people are very rare and are mainly imported by travelers. We report an outbreak of histoplasmosis among healthy Japanese people who traveled to a resort area in Southeast Asia. Three young Japanese women traveled to Langkawi island, Malaysia and stayed on the island for five days without visiting caves, a known reservoir of H. capsulatum. All three individuals developed flu-like symptoms with multiple nodule shadows on chest X rays or chest CT scans at around ten days after their return to Japan. Serum samples obtained from the three subjects were positive for anti-Histoplasma antibody and specific PCR for H. capsulatum on lung biopsy specimens and the serum from one patient was positive. The clinical course of all three patients improved without the use of anti-fungal agents and no recurrence has been confirmed. Clinical attendants should consider histoplasmosis when they see patients with flu-like symptoms with abnormal chest X-rays after visiting H. capsulatum endemic areas, especially Southeast Asia.

Matched MeSH terms: Histoplasmosis/diagnosis*; Histoplasmosis/drug therapy; Histoplasmosis/epidemiology*

Histoplasmosis presenting with progressively worsening backache--a case report

Lachmanan SR, Haniza O, Hisham AN, Subramaniam J, Merican I

Ann Acad Med Singap, 2001 Nov;30(6):656-8.

PMID: 11817299

INTRODUCTION: Bilateral adrenal enlargement is often the result of disseminated malignant disease, and this diagnosis is particularly likely in a patient with severe weight loss. We describe a case with bilateral adrenal enlargement presenting with progressively worsening backache as a prominent symptom.

CLINICAL PICTURE: A 55-year-old man presented with intermittent low back pain which was progressively worsening, fever, anorexia, low back pain and a 10-kg weight loss. He had underlying diabetes mellitus and ischaemic heart disease. He gave a history of travel to caves for worship. Clinically, the most significant findings included nodular lesions in the anterior fauces and left palatoglossal region. Computed tomographic scan revealed bilateral adrenal masses. Biopsies were taken from the palatal nodules, which revealed histiocytes with numerous histoplasma organisms.

TREATMENT: He was commenced on itraconazole 200 mg daily for a period of 9 months. There was a dramatic initial response with settling of his fever and this was followed by subjective improvement in his well-being.

OUTCOME: He is presently on follow-up and has completed 9 months of itraconazole therapy with resolution of all his symptoms and has gained about 10 kg of weight.

Matched MeSH terms: Histoplasmosis/complications*; Histoplasmosis/diagnosis; Histoplasmosis/drug therapy

Concurrent amoebic and histoplasma colitis: a rare cause of massive lower gastrointestinal bleeding

Koh PS, Roslani AC, Vimal KV, Shariman M, Umasangar R, Lewellyn R

World J Gastroenterol, 2010 Mar 14;16(10):1296-8.

PMID: 20222177

Infective colitis can be a cause of massive lower gastrointestinal bleeding requiring acute surgical intervention. Causative organisms include entamoeba and histoplasma species. However, concurrent colonic infection with both these organisms is very rare, and the in vivo consequences are not known. A 58-year-old male presented initially to the physicians with pyrexia of unknown origin and bloody diarrhea. Amoebic colitis was diagnosed based on biopsies, and he was treated with metronidazole. Five days later, the patient developed massive lower gastrointestinal bleeding with hemorrhagic shock. Emergency total colectomy with end-ileostomy was performed. However, he deteriorated and died on the second postoperative day. Histopathological examination revealed multiple deep ulcers at the hepatic flexure where fungal bodies of mycelial and yeast forms were noted. Isolated lymph nodes showed abscess formation with fungal bodies. Infective fungal colitis with Histoplasma capsilatum was diagnosed. In vitro, amoebic parasites can increase virulence and pathogenicity of histoplasma which may account for the fulminant presentation in this patient. Although rare, this unusual dual infection should be considered in the differential diagnosis of infective colitis, as appropriate antimicrobial treatment may prevent progression to massive lower gastrointestinal bleeding, obviating the need for urgent surgical intervention.

Matched MeSH terms: Histoplasmosis/complications*

Oral histoplasmosis in Malaysia: A retrospective analysis of cases reported in Stomatology Unit, Institute for Medical Research during 1995-2016

Noratikah AH, Ajura AJ, Lau SH

Trop Biomed, 2018 Dec 01;35(4):1041-1048.

PMID: 33601851

Histoplasmosis is a systemic fungal infection caused by inhalation of Histoplasma capsulatum, which is mainly found in bird and bat droppings. Oral manifestation of histoplasmosis may be the only initial manifestation of the disease or associated with chronic disseminated histoplasmosis. The first review of oral histoplasmosis among Malaysian population from 1967 to 1994 (27 years) revealed the occurrence of 37 cases, reported by Ng and Siar in 1996. This current study is the updated overview of oral histoplasmosis cases in Malaysia. The objective of the study was to review and describe clinical and demographic profile of oral histoplasmosis in Malaysia and to correlate histopathological features of oral histoplasmosis with patient's immunity status. We reviewed oral histoplasmosis cases diagnosed in Stomatology Unit, Institute for Medical Research (IMR), Kuala Lumpur from 1995 until 2016. The data was retrieved from the Oral Pathology Information system (OPIS) Stomatology Unit, IMR, which is the largest oral pathology database in Malaysia. Information regarding patients' sociodemographic data, medical illness, clinical presentation, histopathological features, and referring healthcare institutions was extracted from the clinical information which accompanied the biopsy request form. A total of 39 cases of oral histoplasmosis were identified from 1995-2016. Majority of them were male (89.7%). The age ranges from 29 to 85 years with mean age of 57.8 years. Almost half of them were Malays (51.3%), followed by Chinese (33.3%), Indians (7.7%), and other races (7.7%). The most common sites of oral histoplasmosis were tongue, gingiva, palate, and alveolar ridge. The main clinical presentation was ulcer (61.5%) whereas 38.5% presented clinically as swelling. 17.9% of patients were seropositive for human immunodeficiency virus (HIV), 12.8% had tuberculosis, 10.3% had diabetes mellitus, and 2.6% with hepatitis C. The incidence of oral histoplasmosis should raise suspicion of hidden immunodepression and may be the first manifestation of acquired immunodeficiency syndrome (AIDS). Early recognition and diagnosis is crucial to reduce risk of morbidity and mortality.

Matched MeSH terms: Histoplasmosis

Fulltext Adrenal histoplasmosis in Cushing's syndrome with bilateral adrenocortical nodular hyperplasia

Tan TT, Choy YW, Norizan MA, Meah F, Khalid BA

Med J Malaysia, 1990 Jun;45(2):154-8.

PMID: 2152020

Adrenal histoplasmosis in Cushing's syndrome of adrenal origin is rare. A patient with Cushing's disease with bilateral nodular hyperplasia and histoplasmosis of both the adrenal glands is described. The diagnosis of histoplasmosis was only made post operatively as the constitutional manifestations, besides being partially masked by hypercortisolism also resemble those of tuberculosis.

Matched MeSH terms: Histoplasmosis/complications*; Histoplasmosis/surgery

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