Undergraduate Medical Education

Permanent URI for this community

https://hdl.handle.net/1805/28231

Browse

Browsing Undergraduate Medical Education by Author "Alali, Muayad"

Now showing 1 - 1 of 1
  • Thumbnail Image
    Item
    Confounding Histoplasmosis in Hodgkin’s Lymphoma
    (2022-03-24) Zhou, Shannon; Friel, Rylee; Holohan, Maggie; Geers, Erica; Alali, Muayad; Belsky, Jennifer
    Case Description: A 17-year-old, black female was diagnosed with Hodgkin’s Lymphoma (HL), confirmed with lymph node biopsy. Initial infectious workup was negative for Histoplasmosis capsulatum (H. capsulatum), and she was started on routine chemotherapy. After 2 cycles of chemotherapy, routine 18FDG/PET scan demonstrated reduction in previous mediastinal adenopathy, but new areas of adenopathy. Due to concern of disease progression in conjunction with new fevers and dyspnea, she had a biopsy which histologically confirmed H. capsulatum with positive IgG and IgM. She was started on antifungal therapy with dose reduction of chemotherapy. FDG/PET scan 5 weeks into antifungal therapy demonstrated continued FDG uptake in previous H. caspulatum concerning areas, and she was continued on both chemotherapy and antifungal therapy. Radiation to her mediastinal mass and persistent areas of FDG uptake is under discussion. Conclusion: Hodgkin lymphoma (HL) is the most common form of lymphoma and classically presents in late adolescent females as lymphadenopathy. 18FDG/PET scans are used to visualize malignant tissue and aid in staging and end of treatment assessment. We present a case of HL whose case was complicated by concurrent H. capsulatum infection, creating a clinical conundrum regarding treatment. Clinical Significance: Acute H. capsulatum infection can appear as a pulmonary consolidation and/or lymphadenopathy with FDG avidity, making it difficult to discern infection from malignancy. This often results in biopsy, chemotherapy reduction, and ambiguity regarding future radiation therapy. Future research should focus on more FDG sensitive tracers to differentiate malignant tissue from infectious or inflammatory tissue. In addition, immunosuppression in the setting of chemotherapy puts patients at risk for opportunistic infections such as H. capsulatum. Screening for opportunistic disease in endemic areas before initiating chemotherapy should be considered.