ACUTE PULMONARY HISTOPLASMOSIS WITH LIVER AND SPLEEN INVOLVEMENT IN ANONENDEMIC AREA - A DIFFERENTIAL-DIAGNOSIS

A case of acute pulmonary histoplasmosis in a non-endemic setting is d escribed. A 36 year-old male patient was admitted because of fever att acks, weakness and dyspnea on exertion. The chest X-ray revealed bilat eral patchy and nodular consolidations and bilateral enlargement of th e hilar lymph nodes. On computed tomography of the abdomen the spleen was enlarged with a longitudinal diameter of 12.7 cm. Respiratory insu fficiency was demonstrated by an arterial oxygen tension (PaO2) of 7.7 1 kPa at rest. Pathological values of liver function tests were indica tive of liver involvement. A transbronchial lung biopsy was performed. Histologic examination of the biopsy specimen revealed scattered smal l nonnecrotizing granulomas with epithelioid cells and multinucleated giant cells. Precipitating antibodies to Histoplasma capsulatum were d etected by immunodiffusion in bronchoalveolar lavage fluid and blood. IgG antibodies to Histoplasma capsulatum yeast antigens were revealed by enzyme immunoassay. The histoplasmin skin test was negative. The pn eumonitis, lymph node and spleen enlargement and the pathological live r function tests resolved within one month without treatment. The PaO2 returned to normal within one week.