60 year-old male presents with rhinorrhea, body aches, and dry cough for two days. He recently moved here from Kentucky. What’s the diagnosis (please note that there are several differentials based on CXR)?
Answer Histoplasmosis
Histoplasma capsulatum is the fungus that causes histoplamosis, and is endemic to soil in the “Histo belt” of the U.S. (including all of Arkansas, Kentucky, Missouri, Tennessee, and West Virginia and parts Alabama, Illinois, Indiana, Iowa, Kansas, Louisiana, Maryland, Mississippi, Nebraska, Ohio, Oklahoma, Texas, and Virginia); it is found internationally as well.
Outbreaks have occurred following digging up the ground at construction at sites where this yeast lives in the soil, but spores can also become airborne and inoculate people.
Most cases are asymptomatic, but it is associated with a variety of pulmonary syndromes and can have extrapulmonary findings such as splenic calcifications. Disseminated disease typically occurs in immunocompromised patients
Treatment includes itraconazole for mild to moderate disease and amphotericin for disease that is severe or widespread disease.
Differentials:
- Blastomycosis
- Septic emboli
- Sarcoidosis
- Tuberculosis (milliary)
- Aspergillosis
- Carcinoid lung tumor
- Atypical or viral pneumonias
