CTICasesAcute Histoplasmosis
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Imaging findings
A chest radiograph showed left hilar lymphadenopathy. CT revealed hilar lymphadenopathy and larger nodules in the lower lobe with satellite nodules, especially along the lymphatics. Another posterior nodule was noted, along with a small nodule on the right lower lobe, featuring a thickened bronchus with debris and beading around it.
Key takeaways
The presentation is classic for a granulomatous fungal infection. Acute histoplasmosis is endemic in Puerto Rico, where the patient had been exploring caves. Antigen levels were very high, and the organism grew on bronchoalveolar lavage (BAL). A serum antigen test suggested acute infection.
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