recurrent histoplasmosis?

Dear Doctor,

i am a 51,F with multiple autoimmune diagnoses ( hashimoto's, neuropathy, relapsing polychondritis).with some shortness of breath on exertion. the cough is pretty intense, but responds a bit to inhalers and medrol. a broncoscpe was done &  found small lesions in the trachea, ( sparing the posterior) and there is some cartilage invovment in the thryroid carltlage as well.
but my question relates to a finding of old granuloma on imaging. (hilar, pretracheal, calcification.)  which has been diagnosed as histoplasmosis ( one lung feild) I was reared in Ohio. i had a serious pneumonia at age nine, that i suspect was disseminaded histo due to very high fever, liver / spleen involement. i was treated with antibiotics. i was also ill as a teen, with mono being diagnosed twice with liver- spleen involvement.DX chronic fatigue syndrome in mid twenties, with cough & liver-spleen involvemen.,  cough  ultimately settled with high dose pred. i also had thrush alot, not related to antibiotic use or inhalers, ( +. cultures) i do not have Aids.
i was never treated with antifungals, and am wondering if an untreated granulatamous ( sorry spelling) process   might be responsible for the autoimmune problems, ( anca test were negative so wegener's ruled out)  Also, i had a problem with household mold ( aspergillus (aspergillosis), strachybotros) that required remediation, and maybe reactivated it? the autoimmune problems happened after that time.. i have never had any histo tests, antigen or otherwise. a biopsy specimen from the flexible bronchcoscope tested for cancer ( negative), but no cytology was done, or staining, or cultures.
i live in the east coast now and histoplasmosis is rarely thought of..? i am wondering what you thoughts are regarding this, and any recomendations for testing. i understand that repeating the bronch may be risky with relapsing polychondritis..
thank you in advance, i know this is a complicated question.

[David Tinkelman, M.D.]

Histoplasmosis is endemic in Ohio and your history strongly suggests that you had it at age nine.  It is also possible that the illnesses you experienced as a teenager were a flare of chronic Histoplasmosis.  While a variety of immunodeficiency diseases (most notably AIDS) can predispose to Histo and can also be manifest by poor body resistance to the disease leading to severe and/or progressive disease, I could find no reports of an association between Histo and autoimmune disease, of any specific type or with the combined form of autoimmune disease.

I believe the answer to your question then is that untreated granulomatous disease, in this case Histoplasmosis, does not cause or predispose to autoimmune disease.

Also, in the absence of  good evidence to confirm reactivation of Histo, consideration of anti-fungal therapy at this time would be inappropriate.

Good luck