Histoplasma capsulatum Infection With Both Granulomatous Features and Fibrosing Mediastinitis Presenting as Shortness of Breath: A Case Report

It is known that Histoplasma capsulatum can cause chronic granulomatous disease or fibrosing mediastinitis, but both presentations occurring in the same patient is exceedingly rare and difficult to diagnose. The patient is a 24-year-old female with a past medical history of asthma, who presented for worsening shortness of breath. Thoracic imaging revealed a large paratracheal mass with a significant mass effect. Endobronchial ultrasound (EBUS) was attempted unsuccessfully, and the patient underwent video-assisted thoracoscopic surgery, which established the diagnosis of fibrosing mediastinitis. Extensive infectious disease workup confirmed Histoplasma infection. She was treated with a course of Itraconazole, pulmonary artery stenting, and rituximab.