**2.3 Treatment in particular forms of histoplasmosis**

## *2.3.1 Mediastinal granuloma, mediastinal lymphadenitis, and fibrosing mediastinitis*

A relatively rare complication of pulmonary histoplasmosis is mediastinal granuloma, characterized by enlarging mediastinal lymph nodes. No treatment is recommended for patients with asymptomatic mediastinal granuloma because the active infection is no longer present [7, 11].

Most often, the granuloma is symptomatic secondary to compression of adjacent structures (the esophagus, pulmonary vessels, and trachea), and in these situations, itraconazole for 6–12 weeks is prescribed frequently. Surgical resection of obstructive masses should be considered in the setting of obstruction or in whom a fistula to adjacent structures with drainage of necrotic material has occurred [38, 39].

Fibrosing mediastinitis is a rare disorder characterized by an excessive fibrotic reaction in the mediastinum, which results from an exaggerated host response to a prior infection located at mediastinal lymph nodes [39].

The symptoms are due to the vascular, esophageal, and central airway compression, and fibrosing mediastinitis represents the most severe complication of pulmonary histoplasmosis [38].
