Metagenomic next-generation sequencing identified Histoplasma capsulatum in the lung and epiglottis of a Chinese patient: A case report. (December 2020)

• Record Type: Journal Article
• Authors: Chen, Jiehua; Li, Yingqin; Li, Zizi; Chen, Gongqi; Liu, Xi; Ding, Li
• Is Part Of: International journal of infectious diseases. Volume 101(2020)
• Page Start: 33
• Page End: 37
• Publication Date: 2020-12
• Subjects: mNGS -- Histoplasma capsulatum -- Epiglottis -- Itraconazole; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2020.09.038
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Histoplasmosis mainly involves the lung, with the uncommon disseminated forms involving other rare sites such as the epiglottis. Metagenomic next-generation sequencing should be considered an important addition to improve the diagnostic yield for Histoplasma capsulatum. Heightened suspicion of inborn errors of immunity is required for who develop disseminated histoplasmosis without acquired immune deficiency. Abstract: Histoplasmosis is an endemic disease mainly occurring in North America and is rare in China. Confirmation of histoplasmosis should be based on a compatible clinical scenario and a positive culture or histopathology. However, there are still many cases that are misdiagnosed or missed, especially in individuals from non-endemic areas. In recent years, metagenomic next-generation sequencing (mNGS) has led to the accurate and timely diagnosis of some rare and complicated infectious diseases. We describe the case of a 27-year-old Chinese man who had chronic progressive pulmonary lesions without any symptoms for more than 1 year, until the lesions reached the epiglottis and led to progressive pharyngeal pain. There were no positive results from bronchoalveolar lavage fluid (BALF) and epiglottis tissue cultures, or from epiglottis and lung pathological examinations, but mNGS was able to identify Histoplasma capsulatum in the epiglottis tissues and BALF as the cause of the lesions. The patient was treated successfully with itraconazole.