Lesson of the month 1

Lobar pulmonary consolidation in an immunocompromised host

Daniel J. Reynolds, Carl A. Andersen, Sumedh S. Hoskote, Hee Eun Lee, Aditya Raghunathan, Sanjay Kalra, Andrew Harold Limper

Research output: Contribution to journalArticle

Abstract

A 19-year-old male with a history of idiopathic panuveitis, currently taking methotrexate and infl iximab, presented to our institution with 6 weeks of cough, dyspnoea and fevers. He had failed outpatient antimicrobial therapy. Computerised tomography (CT) of the chest revealed the presence of a lobar pneumonia and he was treated with broad spectrum antibiotics, which did not improve his symptoms. Bronchoalveolar lavage was performed with a transbronchial lung biopsy because of the diagnostic uncertainty of the patient's presentation. Pathology revealed non-budding yeasts, consistent with Pneumocystis . Serological and urine studies were positive for both Histoplasma and Blastomyces . The diagnosis of Histoplasma pneumonia was made because of the presentation being inconsistent with Pneumocystis pneumonia, and serology, urine and pathology testing being more consistent with Histoplasma . The patient was treated with oral itraconazole and was doing well at follow-up 12 weeks after hospitalisation.

Original languageEnglish (US)
Pages (from-to)595-598
Number of pages4
JournalClinical Medicine, Journal of the Royal College of Physicians of London
Volume16
Issue number6
StatePublished - Dec 1 2016

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Histoplasma
Immunocompromised Host
Lung
Pneumonia
Panuveitis
Blastomyces
Pneumocystis
Urine
Pathology
Pneumocystis Pneumonia
Itraconazole
Bronchoalveolar Lavage
Serology
Cough
Methotrexate
Dyspnea
Uncertainty
Hospitalization
Fever
Outpatients

Keywords

  • Blastomyces
  • Fungi
  • Histoplasma
  • Immunosuppression
  • Pneumocystis
  • Pneumonia

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Lesson of the month 1 : Lobar pulmonary consolidation in an immunocompromised host. / Reynolds, Daniel J.; Andersen, Carl A.; Hoskote, Sumedh S.; Lee, Hee Eun; Raghunathan, Aditya; Kalra, Sanjay; Limper, Andrew Harold.

In: Clinical Medicine, Journal of the Royal College of Physicians of London, Vol. 16, No. 6, 01.12.2016, p. 595-598.

Research output: Contribution to journalArticle

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