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Video

Pediatric Otolaryngology

(A928) Histoplasmosis Mimicking Neoplasm: A Rare Case of Cervical Lymphadenopathy in an Adolescent

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • Christopher N. Bowman, BS

    Medical Student
    University of Virginia School of Medicine
    CHARLOTTE, North Carolina, United States

    • Co-Author(s)

  • Claudia N. Gutierrez, MD MS

    Fellow, Head and Neck Oncology and Microvascular Reconstruction
    University of Virginia Department of Otolaryngology - Head and Neck Surgery
    Miami, Florida, United States

    • Senior Author(s)

  • Ariana G. Greenwell, MD

    Assistant Professor
    University of Virginia Department of Otolaryngology - Head and Neck Surgery
    Charlottesville, VA, United States

Disclosure(s):
Christopher N. Bowman, BS: No relevant relationships to disclose.
Claudia N. Gutierrez, MD MS: No relevant relationships to disclose.
Ariana G. Greenwell, MD: No relevant relationships to disclose.


Introduction: Histoplasmosis is a fungal infection that affects both immunocompetent and immunocompromised individuals, typically associated with pulmonary symptoms and systemic manifestations but is rarely observed as an isolated neck mass. This report highlights a rare case of disseminated histoplasmosis presenting as a submandibular mass in an immunocompetent pediatric patient, emphasizing diagnostic challenges and the importance of environmental exposure history.

Methods: This report describes the case of a 15-year-old Caucasian girl with an 8-month history of a progressively enlarging submandibular mass, concerning for lymphoma. The patient’s demographic data, clinical presentation, exposure history, imaging findings, pathology, and serological testing were reviewed. Analyses emphasized the role of endemic avian exposure in raising suspicion for histoplasmosis and the use of combined imaging, histopathology, and serology in confirming the diagnosis.

Results: Imaging revealed cervical lymphadenopathy, a right upper lung lobe nodular consolidation, and a necrotic right hilar lymph node conglomerate. Fine needle aspiration and excisional biopsy of an enlarged level 1b cervical lymph node indicated a reactive process. Detailed history revealed prolonged exposure to a barn with chicken coops and serological studies confirmed a positive Histoplasma antibody complement fixation result. The patient was treated with itraconazole, leading to significant clinical improvement and resolution of symptoms.

Conclusions: This case underscores the importance of environmental exposure history and targeted diagnostic testing in managing submandibular masses in pediatric patients. To our knowledge, this is the first reported case of disseminated histoplasmosis presenting as a submandibular mass in an immunocompetent pediatric patient. It highlights the value of avian exposure history in endemic areas and the pivotal role of Histoplasma antibody testing in guiding diagnosis and treatment.