Pulmonary histoplasmosis with histoplasmosis tracheitis in a patient with systemic sclerosis: A case report and review of literature.

Histoplasmosis usually presents as a pulmonary disease. However, histoplasmosis tracheitis is an extremely rare presentation that is often misdiagnosed. We present a case of a 41-year-old female, a known case of systemic sclerosis and chronic kidney disease, on steroids and receiving hemodialysis, who presented with persistent fever, dry cough, and vomiting following recovery from COVID-19 infection. Radiography revealed the presence of cavitating lung lesions, and an initial clinical differential diagnosis of granulomatosis with polyangiitis or tuberculosis was made. Bronchoscopic evaluation, however, revealed the presence of a nodule over the tracheal cartilage, which, on histopathology, revealed sheets of histoplasma-laden histiocytes, allowing a diagnosis of histoplasmosis tracheitis. Histoplasmosis tracheitis is a rare and frequently misdiagnosed condition that can delay treatment and worsen outcomes, underscoring the need for awareness and high clinical suspicion for timely, appropriate intervention.