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September 6, 1976

Complications of the Arrested Primary Histoplasmic Complex

Author Affiliations

From the Clinical Laboratories (Dr Schwarz) and Department of Radiology (Dr Schaen), Jewish Hospital, Cincinnati, and the Department of Internal Medicine, Naval Hospital, Pensacola, Fla (Dr Picardi).

JAMA. 1976;236(10):1157-1161. doi:10.1001/jama.1976.03270110053036

THE GAMUT of clinically active and symptomatic histoplasmosis has become well known, especially in endemic areas. Manifestations such as disseminated forms, active histoplasmoma in the young adult, and cavitary pulmonary disease in elderly men are well-recognized syndromes. Less attention has been focused on mechanically induced (noninfectious) complications related to healing or arrested primary infection. Such complications presented here include simple and complicated broncholithiasis, bronchial compression with resulting atelectasis or bronchiectasis, fistula formation from mediastinal lymph nodes, superior vena cava syndrome, and giant mediastinal cyst.

Diagnosis  The presence of Histoplasma capsulatum was established (primarily by microscopy) in the following cases from surgical or autopsy specimens, except in patients 1 and 2 in whom roentgenographic and serologic evidence strongly indicated the diagnosis.

Giant Cyst of the Mediastinum.—  Caseous lymphadenitis during primary infection with H capsulatum is common in the lymph nodes that drain the primary lung lesion. The extent of involvement and