Pulmonary Histoplasmosis Mimicking Metastatic Lung Cancer: A Case Report.

Rüegg, Gion; Zimmerli, Stefan; Trachsel, Maria; Berezowska, Sabina; Engelbrecht, Swantje; Martin, Yonas; Perrig, Martin (2021). Pulmonary Histoplasmosis Mimicking Metastatic Lung Cancer: A Case Report. Diagnostics, 11(2) MDPI 10.3390/diagnostics11020328

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Histoplasmosis is a well-known endemic fungal infection but experience in non-endemic regions is often limited, which may lead to delayed diagnosis and extensive testing. The diagnosis can be especially challenging, typically when the disease first presents with pulmonary nodules accompanied by hilar and mediastinal lymphadenopathy, suggesting a much more common malignant disease. In this situation, a greater FDG uptake in draining lymph nodes in comparison with the associated lung nodule seen in [18F]FDG-PET/CT, the so-called "flip-flop fungus" sign, can help to orientate further diagnostic measures. We report a case of a 56-year-old woman living in Switzerland, a non-endemic region, whose diagnosis of imported histoplasmosis was delayed since the findings had been initially misinterpreted as pulmonary malignancy. Further, histological workup was inconclusive due to lack of specific fungal staining, leading to ineffective treatment and non-resolving disease. This paper intends to highlight the pitfalls in diagnosing Histoplasma capsulatum and presents images of particularities of fungal infections in [18F]FDG-PET/CT, which in our case showed a "flip-flop fungus" sign.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Clinic of Nuclear Medicine
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology
04 Faculty of Medicine > Service Sector > Institute of Pathology > Clinical Pathology
04 Faculty of Medicine > Service Sector > Institute of Pathology
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine

UniBE Contributor:

Rüegg, Gion; Zimmerli, Stefan; Trachsel, Maria; Berezowska, Sabina Anna; Engelbrecht, Swantje; Martin, Yonas Arrefaine and Perrig, Martin

Subjects:

600 Technology > 610 Medicine & health
500 Science > 570 Life sciences; biology

ISSN:

2075-4418

Publisher:

MDPI

Language:

English

Submitter:

Christine Baumgartner

Date Deposited:

11 Mar 2021 08:59

Last Modified:

11 Mar 2021 08:59

Publisher DOI:

10.3390/diagnostics11020328

PubMed ID:

33671319

Uncontrolled Keywords:

PET-CT flip-flop fungus sign histoplasma capsulatum lymphadenopathy necrotic granulomatosis pulmonary lesion

BORIS DOI:

10.48350/153362

URI:

https://boris.unibe.ch/id/eprint/153362

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