CTICasesMiliary Disseminated Histoplasmosis during Chemotherapy for Ovarian Cancer
[...]. Miliary Disseminated Histoplasmosis during Chemotherapy for Ovarian Cancer. CTICases. Published October 8, 2026. https://cticases.com/c/jpjxy
Imaging findings
A 57-year-old woman on platinum-based chemotherapy for ovarian cancer developed cough and dyspnea. The radiograph shows poorly defined pulmonary vessels caused by countless tiny nodules, with no effusion. CT shows numerous uniform nodules a few millimeters in size in a random, miliary distribution with no dominant nodule, and mild hilar lymphadenopathy. Follow-up imaging after treatment showed complete resolution.
Key takeaways
When the pulmonary vessels look indistinct on a radiograph, look for innumerable small nodules. Uniform, tiny, randomly distributed nodules favor miliary infection over metastases, which tend to vary in size. In endemic areas disseminated histoplasmosis is a leading cause of a miliary pattern, even with only mild immunosuppression such as chemotherapy or TNF-alpha inhibitors. Histoplasma enters the bloodstream readily, which explains the splenic calcifications often seen after infection. It usually responds well to itraconazole.
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