Disseminated histoplasmosis presenting as a unilateral cranial nerve VIII mass: A case report

Abstract

OBJECTIVE: To report a unique presentation of disseminated histoplasmosis. STUDY DESIGN: Case report. SETTING: University hospital, tertiary referral center. PATIENT: Our patient presented with vertigo, tinnitus, and unilateral hearing loss, and was initially found to have a 5-mm enhancing left internal auditory canal mass, as revealed by a magnetic resonance imaging (MRI) scan. Subsequently, the patient developed multiple focal neurologic deficits. INTERVENTIONS: Magnetic resonance imaging and treatment with intravenously administered amphotericin B, with subsequent oral administration of itraconazole. MAIN OUTCOME MEASURES: Clinical presentation and imaging findings of Histoplasmosis involving the cranial nerve VIII. RESULTS: A subsequent MRI scan revealed enlargement of the initial lesion and multiple parenchymal lesions. Further workup revealed a pulmonary lesion; the diagnosis of disseminated histoplasmosis was made on the basis of bronchoalveolar lavage culture. CONCLUSION: Infectious processes, including disseminated histoplasmosis, should be considered in the differential of internal auditory canal masses, especially in the setting of rapid progression of symptoms. © 2006, Otology & Neurotology, Inc.