CTICasesMiliary Histoplasmosis in a Kidney Transplant Patient
Imaging findings
Radiograph shows diffuse tiny nodules (miliary pattern) throughout the lungs. CT confirms a beautiful example of randomly disseminated micronodules, consistent with a miliary pattern.
Key takeaways
In an immunosuppressed patient (e.g., kidney transplant recipient) presenting with dyspnea, fever, and cough, and diffuse miliary nodules on imaging, endemic fungal infections like histoplasmosis (common in certain regions) should be high on the differential, alongside tuberculosis. Diagnosis is often confirmed by culture, and cross-reactivity with other fungal antigens (e.g., blastomycosis) can occur on urinary antigen tests. Histoplasmosis is common in areas with bird/bat excrement, often aerosolized.
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