Acute miliary histoplasmosis

Case contributed by Dr Fabien Ho


Exposure to bats (Madagascar). Fever and chills.

Patient Data

Age: 35 years
Gender: Male

Initial Xray


Miliary opacities

Initial CT MIP 5mm


Disseminated solid nodules, perilymphatic and peribronchovascular, in a miliary pattern. 

3 weeks later


Subnormal Xray

3 months later CT


Numerous disseminated lung nodules, with smaller size and cental calcification in some of them.
No more symptoms at the time of this CT scan.

Case Discussion

Bronchioloalveolar lavage found fungal elements later identified as Histoplasma. The patient was treated with rapid clinical improvement. The infection left numerous small micronodules, most of them showing a punctate central calcification. This is a rare presentation of histoplasmosis. In most cases, there are no symptoms nor radiological findings.

Follow-up CT scans showed no evolution of the nodules. 

Dr P. Mascarel also contributed to this case. 

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