The critical role of H. capsulatum antigens in the perpetuation of this process is underlined by the observation that long-term ketoconazole therapy is quite useful for inducing disease remission. Finally, a sarcoidosis-like syndrome, responsive to corticosteroids, has been described in patients with laboratory evidence of H. capsulatum infection. Whether this syndrome is a separate, coexisting disorder or represents an atypical response to the fungal infection is currently unclear. In patients with symptomatic disease severe enough to lead to an etiologic diagnosis, the clinical presentation resembles an acute influenzalike syndrome, including nonproductive cough, pleurisy, shortness of breath, hoarseness, fever, night sweats, myalgias, arthralgias, and weight loss. Erythema nodosum and erythema multiforme may occasionally be seen in this setting.
Regional adenopathy is common, although pleural effusions are uncommon.
Healing may be complete, but often, there is scarring and calcification. Acute cavitary histoplasmosis with ultimate healing has been clearly documented in a few patients with chronic obstructive pulmonary disease secondary to cigarette smoking. The healed pulmonary lesions are usually benign but can be confused with carcinoma, which may lead to unnecessary thoracotomy. Disseminated Histoplasmosis Symptomatic disseminated disease develops in fewer than 1 in 50,000 patients with primary histoplasmosis. Manifestations of transient dissemination, however, such as positive blood and urine cultures and late splenic calcifications, are not uncommonly associated with self-limited acute disease.