Work

Connecting the dots; disseminated histoplasmosis mimicking an infliximab-induced sarcoid-like reaction in anti-PL7 antisynthetase syndrome —a case report

Year: 2026

Type: article

Abstract: Background Histoplasmosis is a fungal infection caused by Histoplasma capsulatum . Immunosuppressed patients are at risk of developing severe disseminated disease. We report a case of disseminated histoplasmosis resulting from reactivation of a latent infection more than four decades after initial exposure in a patient receiving long-term immunosuppressive therapy for connective tissue disease-associated interstitial lung disease (ILD), illustrating diagnostic challenges that can occur. Case presentation A 72-year-old man of Hindustani descent with ILD secondary to anti-PL7-positive antisynthetase syndrome had been receiving long-term therapy with mycophenolate mofetil. Following a provisional diagnosis of Crohn’s disease, his treatment was switched to infliximab. Follow-up high-resolution computed tomography demonstrated the development of new centrilobular and perilymphatic micronodules. Extensive microbiological evaluation of bronchoalveolar lavage fluid yielded negative results. Treatment with corticosteroids for a presumed infliximab-induced sarcoid-like reaction was initiated; however, the radiological abnormalities progressed. Subsequent lung biopsy revealed necrotising granulomatous inflammation. After four weeks of incubation, fungal culture of lung tissue grew Histoplasma capsulatum , establishing the diagnosis of disseminated histoplasmosis with pulmonary and abdominal involvement. Conclusions In immunocompromised patients presenting with a new inflammatory granulomatous lung disease emerging during treatment, reactivation of histoplasmosis should be considered in the differential diagnosis, even when exposure occurred many years earlier.

Source: BMC Pulmonary Medicine

DOI: 10.1186/s12890-026-04714-0

Authors: Iris A. Simons, Lilian J. Meijboom, Jacobus A. Winkelman, Teodora Radonic, Esther J. Nossent

Institutions: Amsterdam UMC Location University of Amsterdam, Amsterdam institute for Immunology and Infectious Diseases, Amsterdam Cardiovascular Sciences, Amsterdam UMC Location Vrije Universiteit Amsterdam

Language: English

Topic: Fungal Infections and Studies

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,090