Spore-casting outcomes: Histoplasma serology in lung nodule risk stratification

BACKGROUND: Lung nodule evaluation is a vital practice in pulmonary medicine. While biopsy remains the diagnostic gold standard, it carries procedural risks. In regions endemic for fungal disease, low-cost, noninvasive testing may help reduce unnecessary procedures. AIM: We seek to evaluate the association between positive endemic histoplasma antibody titers and non-cancerous pathology in patients with pulmonary nodules. Methods: We conducted a simple, retrospective, single-center study of patients diagnosed with solitary (R91.1) or multiple (R91.8) pulmonary nodules. Data collected included Histoplasma antibody results, pathologic diagnoses when available, PET-CT, and clinical course (follow-up CT scans). RESULTS: Positive Histoplasma antibody testing demonstrated an inverse relationship with malignant pathology. However, this association did not reach statistical significance. Conclusions: Histoplasma antibody titers may help identify patients with pulmonary nodules who are less likely to have malignancy, potentially supporting conservative monitoring over biopsy in selected cases. Larger, prospective studies are needed to determine the clinical utility of fungal testing in lung nodule management.