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Complications
By Mayo Clinic staffHistoplasmosis can cause a number of serious complications, even in otherwise healthy people. For infants, older adults and people with compromised immune systems, the potential problems are often life-threatening.
Complications of acute and chronic pulmonary histoplasmosis
- Enlarged lymph nodes. Most people with histoplasmosis have some involvement with the lymph nodes in the central part of the chest. This region lies between your lungs and contains the trachea, esophagus, heart and many small lymph nodes. In a small percentage of people with acute pulmonary histoplasmosis, the lymph nodes may enlarge enough to obstruct the airways or esophagus, making it difficult to breathe or swallow. Sometimes the pulmonary arteries and veins — the large blood vessels in the lungs — also may be blocked.
- Fibrosing mediastinitis. A rare but severe late complication of histoplasmosis, fibrosing mediastinitis occurs when scar tissue from lymph nodes in the chest invades and blocks adjoining structures, especially the esophagus and large blood vessels. Signs and symptoms, such as a cough that brings up blood, chest pain and breathlessness, usually don't appear until the disease is quite advanced. When structures in both lungs are affected, fibrosing mediastinitis can be life-threatening.
- Pericarditis. This is inflammation of the pericardium, the sac that surrounds your heart. Normally, this sac contains a small amount of fluid. But when the pericardium becomes inflamed, the amount of fluid in the sac may increase. This can interfere with the heart's ability to pump blood efficiently. Pericarditis that occurs as a complication of histoplasmosis usually results from inflammation in nearby lymph nodes, rather than from infection of the pericardium itself.
- Arthritis. Joint inflammation, often in conjunction with a skin rash (erythema nodosum), is a common complication of acute pulmonary histoplasmosis. Women are far more likely to be affected than are men. Although the arthritis may persist for months, it usually clears on its own or after a brief course of nonsteroidal anti-inflammatory drugs.
Complications of disseminated histoplasmosis
Disseminated histoplasmosis can affect almost any organ system in your body, leading to a number of serious and potentially fatal complications. Some of these include:
- Adrenal insufficiency. Your adrenal glands, which are located just above your kidneys, produce hormones that give instructions to virtually every organ and tissue in your body. When the glands don't provide enough of these hormones, serious, and potentially life-threatening, problems can occur. Untreated adrenal insufficiency (Addison's disease) is fatal.
- Meningitis. An infection and inflammation of the membranes (meninges) and fluid (cerebrospinal fluid) surrounding your brain and spinal cord, meningitis can be life-threatening. The disease usually strikes suddenly, often with a high fever, severe headache and vomiting. As it progresses, the brain swells and may begin to bleed. Meningitis is fatal in a small percentage of cases. As a complication of histoplasmosis, meningitis occurs primarily in people with compromised immune systems, although it occasionally develops in otherwise healthy people.
