Histoplasmosis: The Daily PANCE Blueprint
A 30-year-old female presents with a 4-day history of cough and mild shortness of breath. The cough is productive of yellowish mucus, and she reports a low-grade fever. She recently spent two weeks exploring bat caves in the Ohio and Mississippi River Valleys as part of a research project. She denies tobacco or alcohol use. Laboratory findings reveal pancytopenia and abnormal liver function. A chest radiograph demonstrates diffuse, fine, nodular interstitial prominence, and a CT scan of the chest reveals diffuse miliary pulmonary infiltrates without mediastinal mass or lymphadenopathy. What is the most likely diagnosis?
A. Aspergillosis
B. Blastomycosis
C. Histoplasmosis
D. Coccidioidomycosis
E. Tuberculosis
Answer and topic summary
The answer is C. Histoplasmosis
This patient has Histoplasmosis, a fungal infection caused by Histoplasma capsulatum. The symptoms of cough, mild shortness of breath, and low-grade fever, along with the history of exploring bat caves in an endemic area, are characteristic of this condition. The chest radiograph and CT findings, along with pancytopenia and abnormal liver function, further support the diagnosis. Histoplasmosis is often found in soil contaminated with bird or bat droppings, and exposure to bat caves is a known risk factor.
Incorrect Answers:
A. Aspergillosis – Typically occurs in immunocompromised patients and lacks a specific association with bat caves.
B. Blastomycosis – Presents with similar symptoms but lacks the specific association with bat caves and bird or bat droppings.
D. Coccidioidomycosis – Associated with the southwestern United States, not the Midwest.
E. Tuberculosis – Lacks the specific association with bat caves and would not typically present with the described radiographic findings.
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