Metagenomic Next-generation Sequencing Identified Histoplasma Capsulatum in Lung and Epiglottis of a Chinese Patient: A Case Report

Abstract Histoplasmosis is an endemic disease mainly occurring in North America and is rare in China. Confirmation of histoplasmosis is supposed to be based on a compatible clinical scenario and a positive culture or histopathology. However, there are still many cases that are misdiagnosed or missed, especially in individuals from non-endemic areas. In recent years, metagenomic next-generation sequencing (mNGS) has led to the accurate and timely diagnoses of some rare and complicated infectious diseases. We describe the case of a 27-year-old Chinese man who had chronic progressive pulmonary lesions without any symptoms for more than 1 year until the lesions reached the epiglottis and led to progressive pharyngeal pain. There were no positive results from bronchoalveolar lavage fluid (BALF) and epiglottis tissue cultures or from epiglottis and lung pathological examinations, but mNGS was able to identify Histoplasma capsulatum in the epiglottis tissues and BALF as the cause of the lesions. The patient was successfully treated with itraconazole.