CTICasesDisseminated Histoplasmosis Mimicking Sarcoidosis in a Liver Transplant Recipient
[...]. Disseminated Histoplasmosis Mimicking Sarcoidosis in a Liver Transplant Recipient. CTICases. Published September 19, 2026. https://cticases.com/c/akyrd
Imaging findings
A 30-year-old liver transplant recipient presented with cough. The chest radiograph showed hilar and mediastinal lymphadenopathy, including a filled-in doughnut sign, with numerous background nodules. CT showed many irregularly shaped nodules, some spiculated or stellate, several with small satellite nodules and one closely related to a pulmonary vein, along with rounded nodules resembling intrapulmonary lymph nodes, all distributed haphazardly and varying in size with a largely perilymphatic pattern. There was bulky mediastinal and hilar lymphadenopathy and no pleural effusion. The spleen was unremarkable. Bronchoscopy with lavage and transbronchial biopsy established histoplasmosis.
Key takeaways
In a transplant recipient with nodules and adenopathy the differential is led by infection and post-transplant lymphoproliferative disorder, with metastatic disease and even sarcoidosis considered, since the perilymphatic distribution and bulky nodes here mimicked sarcoidosis closely. Histoplasmosis in transplant recipients more often appears as miliary disease or consolidation, so large irregular perilymphatic nodules with marked adenopathy are an unusual presentation. The extent of lymphadenopathy argues against blastomycosis, which rarely produces bulky nodes. Immunosuppressed patients are at high risk of dissemination. In old disease, splenic calcifications favor histoplasmosis over prior tuberculosis, which does not typically calcify in the spleen.
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