Fungal Pneumonia: The Daily PANCE Blueprint

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Fungal Pneumonia: The Daily PANCE Blueprint

A 42-year-old male from Ohio with AIDS (last CD4 count is 30) presents to the ER with worsening fever, chills, and a dry cough. He had recently been hiking with friends near some caves. On physical exam, you notice tongue ulcers and hepatomegaly. Labs show pancytopenia. CXR demonstrates bilateral nodular densities. Which of the following is the most likely causative fungus?

A. Coccidioidomycosis
B. Histoplasmosis
C. Cryptococcosis
D. Mucormycosis
E. Blastomycosis

Answer and topic summary

The answer is B. Histoplasmosis

Histoplasma capsulatum is a species of dimorphic fungus. It can cause fungal pneumonia. Risk factors include exposure to bird/bat droppings, travel to the Ohio River and Mississippi River valleys, and an immunocompromised condition. Clinical features include fever, weight loss, dry cough, and tongue ulcers. Imaging may show bilateral nodular densities and mediastinal or hilar lymphadenopathy. The best initial test is a urine and serum antigen test. Bronchoscopy may be needed to establish a diagnosis in some patients. Treatment for severe cases is amphotericin B, but oral therapy with itraconazole is adequate for mild-mod cases.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Pulmonary ⇒ Infectious Pulmonary Disorders ⇒ Pneumonias => Fungal pneumonia

Also covered as part of the Internal Medicine Rotation topic list

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