Neuroendocrine Carcinoma Presenting as Metastasis of Unknown Origin in Cervical Lymph Nodes: An Unwonted Case Report.

UNLABELLED: Histoplasma capsulatum is a dimorphic fungus that grows as a mould in the environment and as a yeast in human tissues causing histoplasmosis. Histoplasmosis varies in clinical presentations and severities of the illness and is endemic in certain areas of North, Central, and South America, Africa, and Asia. A 47-year-old previously healthy male presented with a sudden onset of massive haemoptysis requiring emergent intubation in the emergency department. Bronchoscopy revealed blood clots within the endotracheal tube extending into both main bronchi with active bleeding from both airways. Subsequently, the patient experienced a cardiac arrest with asystole, requiring three rounds of cardiopulmonary resuscitation before achieving return of spontaneous circulation. A computed tomography scan of the chest demonstrated diffuse ground-glass opacities. Collateral information obtained from the patient's family indicated travel to Southeast China two months prior to hospitalization. Histoplasma antigen testing returned positive, and antifungal therapy was initiated. Along with serial suctioning and forceps use via fibreoptic bronchoscopy, cryoextraction of blood clots from the bronchi was performed, leading to successful extubation and hospital discharge. This case highlights the need to consider histoplasmosis in patients who have travelled to endemic areas and present with severe respiratory symptoms.

LEARNING POINTS: Acute pulmonary histoplasmosis can present with life-threatening complications such as massive haemoptysis, even in immunocompetent individuals.A thorough travel and occupational history are critical for diagnosing histoplasmosis, especially in non-endemic regions.Combined management with antifungal therapy and bronchoscopic cryoextraction can be effective in severe pulmonary histoplasmosis with airway obstruction.