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Clinical Features and Outcomes of Patients Diagnosed With Histoplasmosis by Transbronchial Fine Needle Aspiration Biopsy FREE TO VIEW

Tarek Hamieh, MD; Michael Gailey, DO; Chris Jensen, MD; Karl Thomas, MD
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University of Iowa, Iowa City, IA

Chest. 2014;146(4_MeetingAbstracts):729A. doi:10.1378/chest.1995271
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SESSION TITLE: Bronchoscopy Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: The finding of histoplasmosis on transbronchial fine needle aspiration biopsy of mediastinal lymph nodes has become increasingly frequent in endemic regions with the widespread use of endobronchial ultrasound-guided procedures.

METHODS: We conducted a retrospective cohort analysis of all patients who had pathologically-confirmed Histoplasma organisms visualized on TBNA specimens between 2002 and 2013. Clinical features/response to treatment in 38 patients with an average age of 40.7 years (range 15 - 81 years) were analyzed.

RESULTS: 76% (29/38) had at least one symptom attributed to the histoplasmosis. 47% (18/38) had systemic symptoms including 11 with weight loss, 7 fatigue, 4 night sweats and 3 fever. 60% (23/38) had localized chest symptoms including 18 with cough, 13 chest pain/pressure, 9 shortness of breath and 3 dysphagia. 38/38 patients had mediastinal lymphadenopathy by CT scan or EBUS, 34 patients had pulmonary parenchymal nodules(16 bilateral). Of the 27 patients with CT images available for review, 29% (8/27) had calcified mediastinal lymph nodes and 6 of these 8 had clinically significant symptoms. Only 1 patient had mediastinal fibrosis on presentation. The average duration of follow-up was 876 days (range 8 - 4017) from the day of the biopsy. 50% (19/38) of the patients received itraconazole treatment with an average duration of treatment of 6.7 months. Of the 19 patients receiving treatment clinical and radiographic follow-up data were available for 17. 10 had improvement in symptoms. Of the non-responders, 3 of 7 had immunosuppression including pre-existing malignancy. Radiographic follow-up with CT scan demonstrated no change in mediastinal lymph nodes in 12 patients and no change in parenchymal nodules in 9 patients. Only 3 of 17 patients had partial resolution of mediastinal nodes and 3 of 17 had partial resolution of parenchymal nodules. Mediastinal lymphadenopathy increased in 2 patients while parenchymal nodules increased in 6. There was one reported death, all other patients were alive at last known follow-up.

CONCLUSIONS: We report the clinical findings in a large cohort of patients diagnosed with histoplasmosis by TBNA demonstrating a benign clinical course in the majority of patients characterized by resolution of symptoms and radiographic stability in the majority of patients.

CLINICAL IMPLICATIONS: Immunosuppression including systemic steroids or concurrent treatment for malignancy are risk factors for failure to respond to treatment with itraconazole.

DISCLOSURE: The following authors have nothing to disclose: Tarek Hamieh, Michael Gailey, Chris Jensen, Karl Thomas

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