OBJECTIVE: To evaluate cases of chronic pulmonary histoplasmosis diagnosed in recent years at the Complexo Hospitalar Santa Casa in Porto Alegre, in the state of Rio Grande do Sul, Brazil. METHODS: Cases diagnosed at the Santa Casa Hospital Complex within the last 25 years were reviewed. Four cases in which the diagnosis was made through histopathological analysis or culture and confirmed by with serologic testing are described. Cases from the Brazilian literature are also discussed. RESULTS: The principal clinical manifestations were cough, dyspnea, fever, anorexia and weight loss. Among the radiological findings were emphysema, cystic cavities, bronchiectasis and pleural thickening. All patients had an epidemiological history of contact with chicken feces. One of the patients presented Aspergillus fumigatus colonization of cavities. CONCLUSION: Chronic pulmonary histoplasmosis must be considered in patients with chronic obstructive pulmonary disease presenting cavitary lesions of the lung, sputum smear microscopy negative for acid-fast bacilli and negative tuberculin skin test. Hemoptysis occurring in the presence of cured or fading pulmonary lesions is suggestive of Aspergillus colonization.
Histoplasmosis; Histoplasmosis; Histoplasma; Tuberculosis, pulmonary; Itraconazole; Sputum; Diagnosis, Differential
