Acute miliary histoplasmosis

Case contributed by Dr Fabien Ho

Presentation

Exposure to bats (Madagascar). Fever and chills.

Patient Data

Age: 35 years
Gender: Male
X-ray

Initial Xray

Miliary opacities

CT

Initial CT MIP 5mm

Disseminated solid nodules, perilymphatic and peribronchovascular, in a miliary pattern. 

X-ray

3 weeks later

Subnormal Xray

CT

3 months later CT

Numerous disseminated lung nodules, with smaller size and cental calcification in some of them.
No more symptoms at the time of this CT scan.

Case Discussion

Bronchioloalveolar lavage found fungal elements later identified as Histoplasma. The patient was treated with rapid clinical improvement. The infection left numerous small micronodules, most of them showing a punctate central calcification. This is a rare presentation of histoplasmosis. In most cases, there are no symptoms nor radiological findings.

Follow-up CT scans showed no evolution of the nodules. 

Dr P. Mascarel also contributed to this case. 

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Case information

rID: 64909
Published: 4th Jan 2019
Last edited: 4th Mar 2019
System: Chest
Inclusion in quiz mode: Included
Institution: Clinique Sainte Clotilde

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