Focal necrotizing Histoplasma capsulatum cervical lymphadenitis without evidence of disseminated disease in an immunocompetent patient

Previously healthy Caucasian female in her 30s initially presented for progressively enlarging right-sided cervical lymphadenopathy with associated sore throat. After she completed 2 antibiotic regimens for presumed infection with no relief, a CT Neck with contrast was obtained which demonstrated multiple pathologic lymph nodes, the largest lymph node demonstrating central necrosis. Patient underwent fine needle aspiration with Otolaryngology, as well as core needle biopsy with Interventional Radiology, both of which were nondiagnostic. Subsequently, she underwent excisional lymph node biopsy with Otolaryngology. Pathology reported the presence of numerous budding, oval yeast-like cells in the necrotic areas, diagnostic of Histoplasma capsulatum lymphadenitis. She retrospectively received a CT Chest with contrast to confirm presence of pulmonary or mediastinal disease for disseminated histoplasma infection. Surprisingly, the CT Chest showed no evidence of disseminated disease, indicating a unique case of isolated histoplasma capsulatum cervical lymphadenitis.