Histoplasmosis presenting as isolated cervical lymphadenopathy: A rare presentation.

Histoplasmosis is an opportunistic fungal infection caused by inhaling the spores of a fungus called Histoplasma capsulatum. Disseminated histoplasmosis is the most common form associated with acquired immune deficiency syndrome (AIDS). Here, we report a case of histoplasmosis presenting as isolated cervical lymphadenopathy in a human immunodeficiency virus (HIV)-infected patient diagnosed by a less invasive method (fine-needle aspiration cytology) and confirmed by fungal culture of fine-needle aspiration material. Due to varied and nonspecific clinical manifestations of histoplasmosis, most of the infections are misdiagnosed or underreported. It has to be considered in differential diagnosis of cervical lymphadenopathy, particularly in immunocompromised patients so that patients can be treated medically at an early stage before dissemination occurs and unnecessary surgery can be avoided. Here, we present this case because of its rare presentation as isolated cervical lymphadenopathy and classical cytological picture.

Role of self-expanding metallic stents in the management of malignant obstruction of the proximal colon.

PURPOSE: Expandable metal stents have been shown to be effective in the management of malignant large-bowel obstruction. However, right colonic lesions account for less than 5% of all reported cases of colonic stenting. This study was performed to determine the outcomes following stenting for lesions proximal to the splenic flexure. METHODS: The hospital records of patients undergoing stenting for large-bowel obstruction at a district general hospital in northeastern England from 2003 to 2008 were reviewed retrospectively. Data were analyzed to identify patient characteristics, site of obstructing lesion, intent for stenting, and outcomes measured including relief of obstruction, hospital stay, and complications. RESULTS: Stenting was attempted in 97 patients with malignant large-bowel obstruction. Of these, 16 (16.5%) patients had lesions proximal to the splenic flexure: 8 patients had lesions in the ascending colon and 8 patients had lesions in the transverse colon. Self-expanding metal stents were successful in relieving obstruction in 14 (88%) patients with proximal colonic lesions. Stenting was attempted as a bridge to definitive surgery in five patients and for palliation in nine patients. One patient had poststent bleeding that was managed conservatively, and there were no perforations or stent dislodgements. The mean postprocedure hospital stay was 1.6 days. CONCLUSIONS: Self-expanding metal stents are safe and effective in the management of malignant large-bowel obstruction proximal to the splenic flexure. The technical and clinical success rates are comparable with those reported for stenting distal colonic lesions.