Reactivation Histoplasmosis Manifested by Lymphocutaneous Fistula with Cervical Drainage of Stones

Histoplasmosis, the most common endemic fungal infection in the United States, is usually self-limiting but can cause a myriad of unusual manifestations, including lithiasis. Despite more than a century of clinical experience with the disease, controversy persists regarding the potential for latent infection with subsequent reactivation. We report a case of an apparently immunocompetent young woman who developed recurrent histoplasmosis after eight years. The presumed secondary reactivation was complicated by a lymphocutaneous fistula with the drainage of stones from her neck after the initiation of antifungal therapy. This case supports the concept of reactivation histoplasmosis. Patients with histoplasmosis are at risk for paradoxical transiently worsening local inflammation while receiving effective antifungal therapy.