History : 24-yr-old woman with chest pain, asthenia and night sweats. She has flown back from Brasilia to France 3 weeks ago. Case of the Month 5 November.

History: 24-yr-old woman with chest pain, asthenia and night sweats. She has flown back from Brasilia to France 3 weeks ago.

Case of the Month 5November 2015

Case of the Month 5

Case of the Month 5

• Complete regression of symptoms with paracetamol

• At the 2-month follow-up:

Case of the Month 5Evolution

Case of the Month 5

What is your diagnosis ?

History: 24-yr-old woman with chest pain, asthenia and night sweats. She has flown back from Brasilia to France 3 weeks ago.

Question: What are the key findings on the CXR?

Case of the Month 5November 2015

Authors: Nicolas HUETGilbert Ferretti

CHU Grenoble, France

Pulmonary nodule in the left hemithorax

Case of the Month 5

Question: What is shown on the CT images?

Case of the Month 5

Case of the Month 5

Multiple nodules with small halo of ground-glass attenuation

• Complete regression of symptoms with paracetamol

• At the 2-month follow-up:

Case of the Month 5Evolution

Case of the Month 5

What is your diagnosis ?

Case of the Month 5Diagnosis

Pulmonary histoplasmosis

Differential Diagnosis SarcoïdosisTuberculosisPulmonary metastasisOther fungal infection (candidiasis, aspergillosis)

Case of the Month 5Discussion

Pulmonary histoplasmosis is a fungal infection that occurs mainly America, sporadically in Europe.

Infection is caused by breathing in spores of the fungus found in bird and bats droppings.

After an incubation period of 2 weeks, symptoms may be fever, chest pain, dyspnea, cough and hemoptysis but this infection often remains asymptomatic.

Acute phase has a good prognosis, but disseminated forms may occur in infants and immunocompromised patients.

Biological tests (serology, antigenemia, antigenuria) confirm presence of the fungus.

Case of the Month 5Discussion

CHEST RADIOGRAPHY

Multiples ill-defined areas of consolidation

Mediastinal enlargement

HIGH-RESOLUTION CT

Hilar and mediastinal lymphadenopathy

Multiple or solitary ill-defined nodules

After the acute phase: Smooth nodules with central calcification Calcified lymphadenopathy

Case of the Month 5Further Reading

Pulmonary Histoplasmosis1) Guimarães MD et al. Fungal Infection Mimicking Pulmonary Malignancy: Clinical and Radiological Characteristics Lung 2013 Dec;191(6):655-62

2) Chong S et al. Pulmonary fungal infection: imaging findings in immunocompetent and immunocompromised patients Eur J Radiol 2006 Sep;59(3):371-83

3) Gazzoni FF et al. Fungal diseases mimicking primary lung cancer: radiologic-pathologic correlation Mycoses 2014 Apr;57(4):197-208