CTICasesReactivation Histoplasmosis in an Immunocompromised Host
Imaging findings
Chest CT shows a focal area of consolidated, cavitary lung opacification in the upper lobe with significant surrounding interstitial edema, alongside low-attenuation mediastinal and hilar lymphadenopathy.
Key takeaways
The patient, who was severely immunocompromised on infliximab and methotrexate for Crohn's disease, grew Histoplasma capsulatum. Immunocompromised patients on anti-TNF agents (like infliximab) are at high risk for reactivation of histoplasmosis, which often presents as focal cavitary disease or low-attenuation lymphadenopathy resembling tuberculosis, rather than the diffuse miliary pattern typically seen in primary acute dissemination. Occupational exposure, such as crawl space excavation or contact with soil contaminated by bird or bat droppings, is a key risk factor for contracting the fungus.
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