PEDIATRICS Vol. 72 No. 1 July 1983, pp. 99-105
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Unusual Manifestations of Histoplasmosis in Childhood

Geoffrey A. Weinberg MD1, Martin B. Kleiman MD1, Jay L. Grosfeld MD1, Thomas R. Weber MD1, and Lawrence J. Wheat MD1

1 From the Section of Infectious Diseases, Department of Pediatrics, Section of Pediatric Surgery, Department of Surgery, and Division of Infectious Disease, Department of Medicine, Indiana University School of Medicine, Indianapolis

Nine previously healthy children were seen with unique, and in several instances, unreported manifestations of acute histoplasmosis. Presenting manifestations included: obstructive airway disease; subacute parotitis; unilateral cervical lymphadenopathy; anterior mediastinal mass-simulating neoplasm; immune hemolytic anemia; a cutaneous lesion with regional lymphadenopathy; mediastinal mass and pericardial effusion; pulmonary infarction; and a symptom complex of cervical lymphadenopathy, CSF pleocytosis, arthritis, and interstitial nephritis. In eight children histoplasmosis was not initially considered, and the correct diagnosis was made only after complex, and sometimes invasive, diagnostic evaluation and considerable delay. All patients recovered fully without antifungal therapy. Reports of uncontrolled trials of new antifungal agents for treatment of histoplasmosis in immunocompetent hosts should be cautiously evaluated.

Key Words: histoplasmosis • parotitis • lymphadenopathy • immune hemolytic anemia • anterior mediastinal mass

Submitted on May 17, 1982
Accepted on November 2, 1982