Histoplasmosis of the Upper Extremities: Clinical Case,Treatment Algorithm,and Systematic Review

Abstract

Background: Histoplasmosis of the upper extremities is extremely rare, and there is no consensus in its management. The aim of this study was to present a case report and literature review of histoplasmosis in the upper extremities to provide the best treatment recommendation and to increase awareness of this disease. Methods: A systematic review of the literature was performed in PubMed, MEDLINE, and EMBASE databases with the search terms “(Tenosynovitis AND histoplasmosis)” OR “(Upper limbs AND histoplasmosis)” OR “(Upper extremities AND histoplasmosis)” OR “((finger OR arm OR hand OR forearm OR wrist) AND histoplasmosis).” Manuscripts were included in the study if they described diagnosis of histoplasmosis in the bone, joint, synovia, or tendons of the upper extremities. Results: In all, 14 manuscripts and 15 cases of histoplasmosis of the upper extremities from 1992 to 2015 met the inclusion criteria. Eight (53.3%) patients were diagnosed with tenosynovitis, 5 (33.3%) with osteomyelitis, 1 (6.7%) with carpal tunnel syndrome, and 1 (6.7%) with joint wrist abscess. Immunosuppression, travel history, previous diagnosis with histoplasmosis, and persistent symptoms may suggest infectious causes. Surgery and medical treatment together are recommended to optimize outcomes compared with single treatment alone. Conclusions: Histoplasmosis of the upper extremities may have various clinical presentations, including tenosynovitis, osteomyelitis, carpal tunnel syndrome, and joint wrist abscess. The type of surgical approach may depend on the etiology of disease. Increased awareness and knowledge of the clinical signs, symptoms, and effective treatment modalities will help decrease possible complications, such as tendon rupture and functional impairment of the upper extremities.