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.

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Presentation transcript:

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 2015

Case of the Month 5

Complete regression of symptoms with paracetamol At the 2-month follow-up: Case of the Month 5 Evolution

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 5 November 2015 Authors: Nicolas HUET Gilbert 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

 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 5 Evolution

Case of the Month 5 What is your diagnosis ?

Case of the Month 5 Diagnosis Pulmonary histoplasmosis Differential Diagnosis Sarcoïdosis Tuberculosis Pulmonary metastasis Other fungal infection (candidiasis, aspergillosis)

Case of the Month 5 Discussion  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 5 Discussion 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 5 Further Reading Pulmonary Histoplasmosis 1) Guimarães MD et al. Fungal Infection Mimicking Pulmonary Malignancy: Clinical and Radiological Characteristics Lung 2013 Dec;191(6): ) Chong S et al. Pulmonary fungal infection: imaging findings in immunocompetent and immunocompromised patients Eur J Radiol 2006 Sep;59(3): ) Gazzoni FF et al. Fungal diseases mimicking primary lung cancer: radiologic- pathologic correlation Mycoses 2014 Apr;57(4):