Pediatric Infectious Disease

Register      Login

VOLUME 4 , ISSUE 1 ( January-March, 2022 ) > List of Articles

CASE REPORT

Pulmonary Necrotizing Granuloma due to Subclinical Histoplasma Infection

Gregory Stimac, Emily Brezler, Dan Parrish

Keywords : Granuloma, Infectious disease, Pediatric surgery, Pulmonary, Thoracic surgery

Citation Information : Stimac G, Brezler E, Parrish D. Pulmonary Necrotizing Granuloma due to Subclinical Histoplasma Infection. Pediatr Inf Dis 2022; 4 (1):16-18.

DOI: 10.5005/jp-journals-10081-1326

License: CC BY-NC 4.0

Published Online: 08-02-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Aim and objective: To describe the management and outcome of an isolated pulmonary granuloma due to subclinical Histoplasma infection in a pediatric patient. Background: Fungal infections can lead to variable presentations and include isolated organ involvement or disseminated disease. Histoplasmosis is an infection caused by the fungus Histoplasma and is particularly endemic to the Ohio and Mississippi river valleys. Case description: A 16-year-old male presented with shortness of breath and pleuritic chest pain for a 1-year duration. He lived in a home that was occupied by bats. Chest X-rays and computed tomography revealed a right paratracheal calcification. The patient underwent esophagoscopy and right thoracoscopic hilar mass resection. On pathology, the sections showed necrotizing granulomata with giant cells, but no organisms were identified despite full pathological workup. Histoplasma yeast titers were subclinical at 1:8. No further medical management was pursued, and the patient demonstrated resolving symptoms on follow-up. Conclusion: Management of isolated granulomatous disease in pediatric patients is poorly characterized. The most common cause of necrotizing granulomatous inflammation are infections including mycobacteria and fungal infections, but organisms may not be seen on pathological workup. The exact cause of the granuloma may be idiopathic. Treatment is reserved for patients with a severe disease process and degree of symptoms. Practitioners in areas endemic to Histoplasma should suspect it as a cause of isolated lung nodules in the right clinical setting. Clinical significance: Workup of pulmonary granulomas requires a detailed history and physical exam, and isolated pulmonary granulomas in the pediatric population are rare. Practitioners are encouraged to consider infectious etiologies and consider surgical consultation for diagnosis and treatment.


PDF Share
  1. Wheat LJ, Freifeld AG, Kleiman MB, et al. Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis 2007;45(7):807–825. DOI: 10.1086/521259.
  2. Woodard BH, Rosenberg SI, Farnham R, et al. Incidence and nature of primary granulomatous inflammation in surgically removed material. Am J Surg Pathol 1982;6(2):119–130. DOI: 10.1097/00000478-198203000-00004Available from: http://journals.lww.com/00000478-198203000-00004.
  3. Ohshimo S, Guzman J, Costabel U, et al. Differential diagnosis of granulomatous lung disease: clues and pitfalls. Eur Respir Rev 2017;26(145):1–16. Available from: 10.1183/16000617.0012-2017.
  4. Mukhopadhyay S, Gal AA. Granulomatous lung disease: an approach to the differential diagnosis. Arch Pathol Lab Med 2010;134(5):667–690. DOI: 10.5858/134.5.667Available from: https://meridian.allenpress.com/aplm/article/134/5/667/461054/Granulomatous-Lung-Disease-An-Approach-to-the.
  5. Aubry MC. Necrotizing granulomatous inflammation: what does it mean if your special stains are negative? Mod Pathol 2012;25(September 2011):31–38. DOI: 10.1038/modpathol.2011.155.
  6. Panigada S, Ullmann N, Sacco O, et al. Necrotizing sarcoid granulomatosis of the lung in a 12-year-old boy with an atypical clinical course. Pediatr Pulmonol 2012;47(8):831–835. DOI: 10.1002/ppul.22503.
  7. Al-Binali AM, Scott B, Al-Garni A, et al. Granulomatous pulmonary disease in a child: an unusual presentation of Crohn's disease. Pediatr Pulmonol 2003;36(1):76–80. DOI: 10.1002/ppul.10301.
  8. Hammoud ZT, Rose AS, Hage CA, et al. Surgical management of pulmonary and mediastinal sequelae of histoplasmosis: a challenging spectrum. Ann Thorac Surg 2009;88(2):399–403. Available from: 10.1016/j.athoracsur.2009.04.041.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.