Histoplasmosis misdiagnosed as malignancies in immunocompetent and immunocompromised patients: A global perspective on clinical presentation, radiological and pathological findings

The clinical presentation of histoplasmosis is non-specific and has several mimics as documented in the literature. Regarding cancers, previous reviews emphasized mainly the clinical and radiological similarities between histoplasmosis and pulmonary malignancies. Besides lung cancers, histoplasmosis also masquerades as other malignancies. We identified one hundred and twenty-four cases of histoplasmosis clinically mistaken for malignancies. Of the 124,84 (67.7%) were included in the analyses of demographics, immune status, clinical features, diagnosis, and treatment outcomes. The remainder were excluded as the available data was mainly on diagnosis. Of the eighty-four, histoplasmosis was predominantly misdiagnosed as lung cancers (n = 16, 19.0%), gastrointestinal tumors (n = 15, 17.9%), and lymphomas/hematological malignancies (n = 15, 17.9%). Fifty-four (64.3%) were immunocompromised including 16 (29.6%) who were living with HIV, while the remainder were immunocompetent. We conclude that infective aetiologies like histoplasmosis should be considered or ruled out in patients clinically suspected of malignancy regardless of their immune status.