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OBJECTIVES: On December 1905 Darling, resident histopathologist on the Panama Channel area, observed a parasite in the large mononuclear cells of different organs. Negroni in 1914 described the first Argentinean case. Lung, oral, nasal, and laryngeal involvement are common. On the other hand, genital involvement is uncommon. The objective of this war is to communicate the case of a patient with genital histoplasmosis. METHODS/RESULTS: A 60-year-old Argentinian male started two years before with penile lesions and pruritus. Two partial penile resections had been performed in 1999, but pathology reports were not available. The lesions evolved towards ulceration and bleeding. Surgical toilette was carried out. A partial penectomy and glanuloplasty with an original technique were performed. Pathology revealed intracellular and extracellular spherical microorganisms. Morphologically it was histoplasma capsulatum. The histoplasmosis is an endemic mycosis. The infection takes place when inhaling the microconidiae of the fungus filamentous phase. Only a small number of people develop the disease after infection. Diagnosis is made by discovering of 2-3 micron yeasts with Giemsa stain. CONCLUSIONS: If a patient from the histoplasmosis endemic area has a granular lesion, a mycotic disease should be considered.

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Relato do caso de um paciente com queixa de disfagia rapidamente progressiva, cujos exames radiológico e endoscópico demostraram a presença de lesao estenosante do terço distal do esôfago. A biopsia da mesma revelou a presença de fungos, cuja cultura mostrou tratar-se de Histoplasma capsulatum. A dilataçao endoscópica da lesao, indicada por falha do tratamento clínico específico, provocou ruptura esofágica. Foi realizada esofagectomia subtotal com remissao dos sintomas.

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The authors report a case of a patient with complaint of progressive disphagia. Stenoses of lower third of esophagus was revealed by radiological and endoscopic examinations. Fungi were showed in biopsy of lesion, with demonstration of Histoplasm capsulate by tissue culture. Endoscopic dilatation was performed because especific medical treatment failed but esophageal rupture was observed. Partial esophagectomy was performed with symptoms remission.

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From 1989 to 1994, 71 patients were hospitalized for diagnosis of round lung lesions including 49 servicemen under the age of 45 years who had been stationed in tropical areas. In 6 of these servicemen, the diagnosis was pulmonary histoplasmosis at the tertiary stage of histoplasmoma. All had done duty in French Guyana and were negative for human immunodeficiency virus. The subpleural lung opacity was the only lesion in 5 out of 6 patients and was calcified in 4 out of 6 patients. Since skin tests with histoplasmin and serologic testing for histoplasmosis failed to achieve definitive diagnosis, surgical biopsy was performed by conventional thoracotomy in 2 cases and video-assisted thoracic surgery in 4 cases. The specimens obtained confirmed diagnosis of histoplasmosis on mycologic criteria in 3 cases and on a combination of findings including compatible histologic evidence in 3 cases. Treatment consisted in surgical excision of the nodules, for which video-assisted thoracoscopic surgery proved to be an excellent technique because of its simplicity and rapidity.

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A 63-year-old man who grows orchids as a hobby, fell ill with weakness and pain in his hips and legs 2 months after his latest trip to South America (Ecuador). The WBC count was 9900/microliters with unremarkable differential count while blood sedimentation rate was raised to 60/100 mm. The chest X-ray demonstrated in the right upper lobe a well-circumscribed coin lesion (3 cm diameter) of soft-tissue density, uncalcified and without cavitation. Computed tomography in addition revealed an enlarged lymph-node at the lower hilar pole, but no mediastinal lymphoma. Bronchoscopy demonstrated narrowing of a subsegmental ostium of the 6th segment on the right. An attempt at transbronchial biopsy failed. As a peripheral bronchial carcinoma was suspected, a posterolateral thoracotomy was performed (4 months after the trip to Ecuador). Rapid histological examination was negative for tumour and the lesion was therefore enucleated. Histologically (Grocott silver staining) a histoplasmoma was diagnosed. Several serum samples were positive for precipitating (M-band) and complement-binding antibodies (titre 12 days preoperatively was 1:16). The postoperative course was without complication. No anti-histoplasma antibodies were demonstrable 1 year postoperatively.

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A 48-year-old man with a long-standing history of communicating hydrocephalus is reported. Ventriculoperitoneal shunting led to clinical improvement, but symptoms recurred despite surgical re-exploration switching the shunt to an atrial drainage. Ten months after the last surgical procedure, an acute myelopathy developed. Concomitant pharyngeal granuloma examination identified Histoplasma capsulatum (Hc) yeasts. Despite initial response to amphotericin B, Hc was isolated from cerebrospinal fluid (CSF), valve reservoir and distal catheter after two courses of therapy. Fluconazole successfully sterilized CSF, but transverse myelopathy persisted unchanged, and shunting was needed to control hydrocephalus.

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