A RARE PRESENTATION OF HISTOPLASMOSIS DIAGNOSED BY EUS

Document Type : Case Reports

Authors

1 Department of Gastroenterology, Instituto do Câncer do Estado de São Paulo (ICESP), University of São Paulo, São Paulo, SP, Brazil

2 Department of Gastroenterology, Instituto do Cancer do Estado de São Paulo (ICESP), University of Sao Paulo, Sao Paulo, SP, Brazil

3 INSTITUTO DO CANCER DO ESTADO DE SAO PAULO

Abstract

A 24-years-old woman patient with no medical history, complaining of dyspepsia for a year, underwent an esophagogastroduodenoscopy. It was detected a subepithelial lesion at the anterior wall of the thoracic esophagus 28 cm from the incisors, with an elongated appearance and a central orifice, measuring 6 mm (A). The patient denied previous surgeries or recent travel.

At endoscopic ultrasound (EUS) the subepithelial lesion corresponded to a lymph node conglomerate, composed of three coalesced lymph nodes, measuring 25x17 mm, located between the left atrium, the pulmonary artery and the esophagus (B).

This lymph node conglomerate presented contiguity with the esophageal wall, which was thickened. No other lymph nodes enlargement was

identified. FNB (Acquire®, Boston Scientific, Marlborough, Massachusetts, USA) was performed with a 22 Gauge needle.

Histology revealed a chronic granulomatour process, with caseous necrosis (C). The research for fungus resulted positive with small yeast-like structures, without budding aspects compatible with histoplasmosis (D).

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