Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Mediastinal histoplasmosis presenting with esophageal involvement and dysphagia: Case study

  • 73 Accesses

  • 12 Citations


Esophageal involvement with histoplasmosis is uncommon, but has been recognized in two clinical settings. Most commonly, the esophagus becomes involved as a result of contiguous mediastinal lymphadenopathy. Such patients usually present with dysphagia secondary to midesophageal compression or stricture. The esophagus can also be involved in cases of disseminated histoplasmosis. Esophageal ulcers or nodular lesions are the usual clinical manifestations in this setting. We report a case of mediastinal histoplasmosis with esophageal narrowing and mucosal ulceration that presented with dysphagia. The diagnosis was established at thoracotomy by the histologic finding of necrotizing granulomas and a positive fungal stain. The case was successfully treated with amphotericin B. The literature on esophageal and gastrointestinal histoplasmosis is reviewed.

This is a preview of subscription content, log in to check access.


  1. 1.

    Wheat LJ, Slama TG, Eitzen HE, Kohler RB, French MLV, Biesecker JL: A large urban outbreak of histoplasmosis: clinical features. Ann Intern Med 94:331–337, 1981

  2. 2.

    Fifer WR, Woellner RC, Gordon SS: Mediastinal histoplasmosis: report of three cases with dysphagia as the presenting complaint. Dis Chest 47:518–526, 1965

  3. 3.

    Lee KR, Lin F: Gastrointestinal histoplasmosis: roentgenographic, clinical and pathological correlation. Am J Gastroenterol 63:255–265, 1975

  4. 4.

    Jenkins DW, Fisk DE, Byrd RB: Mediastinal histoplasmosis with esophageal abscess: two case reports. Gastroenterology 70:109–111, 1976

  5. 5.

    Schneider RP, Edwards W: Histoplasmosis presenting as an esophageal tumor. Gastrointest Endosc 23:158–159, 1977

  6. 6.

    Wieder S, Rabinowitz JG: Fibrous mediastinitis: a late manifestation of mediastinal histoplasmosis. Radiology 125:305–312, 1972

  7. 7.

    Rabinowitz JG, Prater W, Silver J, Phillips JC, Wieder S: Mediastinal histoplasmosis. Mt Sinai J Med 47:356–363, 1980

  8. 8.

    Gilliland MD, Scott LD, Walker WE: Esophageal obstruction caused by mediastinal histoplasmosis: beneficial results of operation. Surgery 95:59–62, 1984

  9. 9.

    Garrett HE Jr, Roper CL: Surgical intervention in histoplasmosis. Ann Thorac Surg 42:711–722, 1986

  10. 10.

    Coss KC, Wheat LJ, Conces DJ Jr, Brashear RE, Hull MT: Esophageal fistula complicating mediastinal histoplasmosis: response to amphotericin B. Am J Med 83:343–346, 1987

  11. 11.

    Urschel HC Jr, Razzuk MA, Netto GJ, Disiere J, Chung SY: Sclerosing mediastinitis: improved management with histoplasmosis titer and ketoconazole. Ann Thorac Surg 50:215–221, 1990

  12. 12.

    Case Records of the Massachusetts General Hospital: case 15-1991. N Engl J Med 324: 1049–1056, 1991

  13. 13.

    Dow CJ: Oesophageal tuberculosis: four cases. Gut 22:234–236, 1981

  14. 14.

    Rosario MT, Raso CL, Comer GM: Esophageal tuberculosis. Dig Dis Sci 34:1281–1284, 1989

  15. 15.

    Gordon AH, Marshall JB: Esophageal tuberculosis: definitive diagnosis by endoscopy. Am J Gastroenterol 85:174–177, 1990

  16. 16.

    Newman RM, Fleshner PR, Lajam FE, Kim U: Esophageal tuberculosis: a rare presentation with hematemesis. Am J Gastroenterol 86:751–755, 1991

  17. 17.

    Eng J, Sabaratnan S: Tuberculosis of the esophagus. Dig Dis Sci 39:536–549, 1991

  18. 18.

    Peabody JW Jr, Brown RB, Davis EW, Katz S, Cannon A: Surgical implications of mediastinal granulomas. Am Surg 25:357–368, 1959

  19. 19.

    Rodgers RF, Applebaum MI, Heredia RM: Esophageal compression in association with silicosis and Mycobacterium intracellulare. Chest 76:701–703, 1979

  20. 20.

    Polachek AA, Matre WJ: Gastrointestinal sarcoidosis: report of a case involving the esophagus. Am J Dig Dis 9:429–433, 1964

  21. 21.

    Johnson DA: Esophageal involvement in other inflammatory conditions. In: Castell DO (e..) The Esophagus. Boston: Little, Brown and Company, 1992, pp 687–704

  22. 22.

    Forsmark CE, Wilcox CM, Darragh TM, Cello JP: Disseminated histoplasmosis in AIDS: an unusual bleeding. Gastrointest Endosc 36:604–605, 1990

  23. 23.

    Hull PR: Systemic histoplasmosis with oesophageal obstruction due to Histoplasma granulomas: successful treatment with rifampicin an amphotericin B. S Afr Med J 55:639–640, 1979

  24. 24.

    Tu RK, Peters ME, Gourley GR, Hong R: Esophageal histoplasmosis in a child with immunodeficiency with hyper-IgM. Am J Roentgenol 157:381–382, 1991

  25. 25.

    Goodwin RA Jr, Shapiro JL, Thurman GH, Thurman SS, Des Prez RM. Disseminated histoplasmosis: clinical and pathologic correlations. Medicine 59:1–33, 1980

  26. 26.

    Sturim HS, Kouchoukos NT, Ahlvin RC: Gastrointestinal manifestations of disseminated histoplasmosis. Am J Surg 110:435–440, 1965

  27. 27.

    Hinshaw RJ, Guilfoil PH: Intramural cystic lesion of the esophagus due to Histoplasma capsulatum. Dis Chest 47:555–556, 1965

  28. 28.

    Parsons RJ, Zarafonetis CJD: Histoplasmosis in man: report of seven cases and a review of seventy-one cases. Arch Intern Med 75:1–23, 1945

  29. 29.

    Weiss ED, Haskell BF: Anorectal manifestations of histoplasmosis. Am J Surg 84:541–544, 1952

  30. 30.

    Shull HJ: Human histoplasmosis: a disease with protean manifestations often with digestive system involvement. Gastroenterology 25:582–595, 1953

  31. 31.

    Reddy P, Gorelick DF, Brasher CA, Larsh H: Progressive disseminated histoplasmosis as seen in adults. Am J Med 48:629–636, 1970

  32. 32.

    Sarosi GA, Voth DW, Dahl BA, Doto IL, Tosh FE: Disseminated histoplasmosis: results of long-term follow-up. Ann Intern Med 75:511–516, 1971

  33. 33.

    Smith JW, Utz JP: Progressive disseminated histoplasmosis: a prospective study of 26 patients. Ann Intern Med 76:557–565, 1972

  34. 34.

    Fisher JR, Sanowski RA: Disseminated histoplasmosis producing hypertrophic gastric folds. Am J Dig Dis 23:282–285, 1978

  35. 35.

    Orchard JL, Laparello F, Brunskill D: Malabsorption syndrome occurring in the course of disseminated histoplasmosis: case report and review of gastrointestinal histoplasmosis. Am J Med 66:331–335, 1979

  36. 36.

    Miller DP, Everett ED: Gastrointestinal histoplasmosis. J Clin Gastroenterol 1:233–236, 1979

  37. 37.

    Lee SH, Barnes WG, Hodges GR, Dixon A: Perforated granulomatous colitis caused by Histoplasma capsulatum. Dis Colon Rectum 28:171–176, 1985

  38. 38.

    Alberti-Flor JJ, Granda A: Ileocecal histoplasmosis mimicking Crohn's disease in a patient with Job's syndrome. Digestion 33:176–180, 1986

  39. 39.

    Cappell MS, Mandell W, Grimes MM, Neu HC: Gastrointestinal histoplasmosis. Dig Dis Sci 33:353–360, 1988

  40. 40.

    Brett MT, Kwan JTC, Bending MR: Caecal perforation in a renal transplant patient with disseminated histoplasmosis. J Clin Pathol 41:992–995, 1988

  41. 41.

    Graham BD, McKinsey DS, Driks MR, Smith DL: Colonic histoplasmosis in acquired immunodeficiency syndrome: report of two cases. Dis Colon Rectum 34:185–190, 1991

  42. 42.

    Clarkston WK, Bonacini M, Peterson I: Colitis due to Histoplasma capsulatum in the acquired immune deficiency syndrome. Am J Gastroenterol 86:913–916, 1991

  43. 43.

    Kerr A, Dix J, Quinnonez C: A case of fatal hemorrhage caused by intestinal histoplasmosis. Am J Gastroenterol 86:910–912, 1991

  44. 44.

    Ferguson TB, Burford TH: Mediastinal granuloma: a 15-year experience. Ann Thorac Surg 1:125–141, 1965

  45. 45.

    Feigin DS, Eggleston JC, Siegelman SS: The multiple roentgen manifestations of sclerosing mediastinitis. Johns Hopkins Med J 144:1–8, 1979

  46. 46.

    Dukes RJ, Strimlan CV, Dines DE, Payne WS, MacCarty RL: Esophageal involvement with mediastinal granuloma. JAMA 236:2313–2315, 1976

  47. 47.

    Dines DE, Payne WS, Bernatz PE, Pairolero PC: Mediastinal granuloma and fibrosing mediastinitis. Chest 75:320–324, 1979

  48. 48.

    MacCarty RL, Dukes RJ, Strimlan CV, Dines DE, Payne WS: Radiographic findings in patients with esophageal involvement by mediastinal granuloma. Gastrointest Radiol 4:11–16, 1979

  49. 49.

    Rex DK, Tarver RD, Wiersema M, O'Conner KW, Lappas JC, Tabatowski K: Endoscopic transesophageal fine needle aspiration of mediastinal masses. Gastrointest Endosc 37:465–468, 1991

  50. 50.

    Wiersema MJ, Hawes RH, Tao L, Wiessema LM, Kopecky KK, Rex DK, Kumar A, Lehman GA: Endoscopic ultrasonography as an adjunct to fine needle aspiration cytology of the upper and lower gastrointestinal tract. Gastrointest Endosc 38:35–39, 1992

  51. 51.

    Ulbright TM, Katzenstein AA: Solitary necrotizing granulomas of the lung: differentiating features and etiology. Am J Surg Pathol 4:13–28, 1980

  52. 52.

    Mark EJ: Lung Biopsy Interpretation. Baltimore: Williams and Wilkins, 1984

  53. 53.

    Chandler FW, Watts JC: Histoplasmosis capsulati. In: Pathologic Diagnosis of Fungal Infections. Chicago: ASCP Press, 1987, pp 123–139

Download references

Author information

Correspondence to John B. Marshall MD, FACP, FACG.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Marshall, J.B., Singh, R., Demmy, T.L. et al. Mediastinal histoplasmosis presenting with esophageal involvement and dysphagia: Case study. Dysphagia 10, 53–58 (1995).

Download citation

Key words

  • Histoplasmosis
  • Granulomatous diseases
  • Necrotizing granulomas
  • Esophageal stricture
  • Esophagitis
  • Dysphagia
  • Deglutition
  • Deglutition disorders