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Chest Infections |

The Use of Endobronchial Ultrasound in the Diagnosis of Subacute Pulmonary Histoplasmosis

J. Ferguson*, MD; Katarine Egressy, MD; Mohammed Mohammed, MD
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University of Wisconsin, Madison, WI


Chest. 2012;142(4_MeetingAbstracts):222A. doi:10.1378/chest.1390848
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Abstract

SESSION TYPE: Respiratory Infections Posters II

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Physicians often rely on multiple tests to establish a diagnosis of pulmonary histoplasmosis. Subacute pulmonary histoplasmosis (SPH) is characterized by infection with Histoplasma casulatum and the presence of symptoms for > 1 month with a localized pulmonary opacity and/or hilar and mediastinal adenopathy. SPH is particularly challenging to diagnose, as it often affects immunocompetent individuals in whom identification of the organism and antigen detection are often negative. Endobronchial ultrasound (EBUS) with transbronchial needle aspiration (TBNA) is a useful tool in the investigation of hilar and mediastinal adenopathy but it is not known if EBUS-TBNA provides useful information that can aid in the diagnosis of SPH. We hypothesized that EBUS would provide additional confirmatory information for diagnosis in individuals suspected of SPH.

METHODS: We retrospectively reviewed patients with mediastinal and/or hilar adenopathy referred to our institution for EBUS who were believed to be suffering from SPH. We collected information on symptoms, physical exam findings, EBUS findings, cultures, pathology, serology and antigen detection.

RESULTS: Six patients were reviewed. All had symptoms (fever, sweats, chest pain, cough) for > 1 month. One patient had hilar adenopathy alone, 5 had had mediastinal and hilar adenopathy. Pathology examination of the nodal material revealed granulomatous inflammation in 5 and necrosis in 1. None of the material demonstrated fungal organisms. All patients had positive serology. One patient had antigenuria and one had antigenemia. Culture material was negative in all patients.

CONCLUSIONS: EBUS-TBNA provided findings that are consistent with SPH but not confirmatory in this small case series. SPH was always associated with positive serology, but infrequently associated with antigen detection. Histoplasmosis was not detected by pathology or culture in any patient.

CLINICAL IMPLICATIONS: EBUS-TBNA does not confirm a diagnosis of SPH but can provide information that is consistent with the diagnosis. EBUS-TBNA may be useful in eliminating other causes of hilar and mediastinal adenopathy.

DISCLOSURE: The following authors have nothing to disclose: J. Ferguson, Katarine Egressy, Mohammed Mohammed

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University of Wisconsin, Madison, WI

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