CTICasesDisseminated Pulmonary Blastomycosis in a Kidney Transplant Recipient
Imaging findings
A kidney transplant recipient develops a cough, and serial portable radiographs progress from an unremarkable initial film to consolidation with volume loss in the right upper lobe and a background of multiple irregular large nodules; a subsequent CT confirms numerous nodules including a larger dominant nodule with satellite nodules, notably without pleural effusion and with only modest, mild mediastinal lymphadenopathy, plus some bronchus intermedius narrowing suggesting airway involvement.
Key takeaways
The combination of multiple nodules with a dominant lesion and satellites, absent pleural effusion, and only minimal lymphadenopathy is a recognized pattern favoring pulmonary blastomycosis over other fungal or infectious causes, in contrast to histoplasmosis which typically shows more prominent, sometimes disproportionate lymphadenopathy; the same pleural-effusion-sparing pattern may also apply to cryptococcosis. Kidney transplant recipients, who tend to be less immunosuppressed and more ambulatory and exposed than lung transplant recipients, appear prone to disseminated disease with multi-organ involvement, and treatment with amphotericin is complicated by its nephrotoxicity in this population; disease latency after exposure can extend up to about three months.
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