CTICasesChronic Pulmonary Histoplasmosis
Imaging findings
Chest CT in a patient with severe centrilobular and paraseptal emphysema demonstrates a large, thick-walled cavity in the right upper lobe surrounded by dense consolidation, adjacent pleural thickening, and widespread endobronchial tree-in-bud nodularity. Microbiologic workup of the sputum and bronchoalveolar lavage fluid grew out Histoplasma capsulatum.
Key takeaways
Chronic pulmonary histoplasmosis is a rare clinical manifestation of histoplasmosis that occurs almost exclusively in patients with pre-existing chronic obstructive pulmonary disease (COPD) or emphysema. It typically presents as a progressive, upper-lobe-predominant cavitary disease that clinically and radiologically mimics tuberculosis or non-tuberculous mycobacterial (NTM) infections. Unlike acute histoplasmosis, this chronic cavitary form requires systemic antifungal therapy with triazoles to prevent progressive lung destruction.
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