RT Journal Article
SR Electronic
T1 Lesson of the month 1: Lobar pulmonary consolidation in an immunocompromised host
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 595
OP 598
DO 10.7861/clinmedicine.16-6-595
VO 16
IS 6
A1 Daniel J Reynolds
A1 Carl A Andersen
A1 Sumedh S Hoskote
A1 Hee Eun Lee
A1 Aditya Raghunathan
A1 Sanjay Kalra
A1 Andrew H Limper
YR 2016
UL http://www.rcpjournals.org/content/16/6/595.abstract
AB A 19-year-old male with a history of idiopathic panuveitis, currently taking methotrexate and infliximab, 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.