Histoplasma capsulatum causing sinusitis: a case report in French Guiana and review of the literature

Abstract

Background: American histoplasmosis is a mycosis caused by Histoplasma capsulatum. A variety of clinical features of histoplasmosis have been commonly described ranging from asymptomatic infections to severe pulmonary infections. In immunocompromised individuals, progressive disseminated forms are frequent, leading to fatal outcome if untreated. However, H. capsulatum sinusitis is unusual with a few cases documented over the last three decades and may be underdiagnosed or confused with other fungal aetiologies, especially outside endemic regions.

Case presentation: In this study, we report an atypical case of Histoplasma capsulatum sinus fungus ball-like in a patient with Acquired Immunodeficiency Syndrome due to Human Immunodeficiency Virus complicated by a disseminated histoplasmosis with a death ending. Diagnosis relied on CT-Scan imaging and on both direct examination of H. capsulatum yeast forms (Gomory methenamine Grocott) in the sinus specimen (aspirate, biopsy) and on positivity of the culture further confirmed by qPCR.

Conclusions: Since last few decades, among the eight reviewed patients, H. capsulatum sinusitis occurred mostly in HIV-immunocompromised patients and for three cases as a sinusitis with disseminated histoplasmosis. Even if this is a rare clinical presentation, its diagnosis is crucial as it could represent an early expression of an Histoplasma capsulatum exposure that can evolve into a disseminated fatal infection when immunity decreases.

Keywords: AIDS; Histoplasma capsulatum; Review; Sinus fungus ball; Sinusitis.

Fig. 1

Representative Computerized-Tomography Scan (CT-Scan) of the sinuses showing complete opacification of right maxillary sinus with flocculent calcifications and an absence of bone erosion

Fig. 2

Gomory Methenamine-Silver Grocott staining of the sinus aspirate showing ovoid 2–4 μm yeasts compatible with Histoplasma capsulatum var. capsulatum