A 45-year-old Male with Cough, Shortness of Breath and Constitutional Symptoms

Abstract

A 45-year-old painter was admitted with a five day-history of a dry cough, headache, shortness of breath, and fever. His complaints started 10 days after he finished the remodeling of an old house. His physical exam was non-focal, and he had no rashes or lymphadenopathy. His blood tests showed white blood cell count of 12.7 × 10⁹/μL and his kidney and liver function tests were within normal limits. Lumbar puncture results and human immunodeficiency virus infection (HIV) test were negative. His chest X-ray showed bilateral interstitial opacities. Lung computed tomography scans showed bilateral parenchymal micronodules. The patient’s blood and bronchoalveolar lavage cultures were negative. He was diagnosed with atypical community-acquired pneumonia (CAP) and discharged on a course of azithromycin. The patient was lost to follow-up until he presented to our hospital four months later with constitutional symptoms. He reported night sweats and fever, poor appetite, dry cough, and shortness of breath. Follow-up chest imaging showed an increase in the size of the pulmonary nodules. He underwent video-assisted thoracoscopy with a lung biopsy. Biopsy staining showed pulmonary histoplasmosis. He was started on a six-month course of oral itraconazole and discharged. His symptoms improved gradually, and he continues to be followed-up in the outpatient clinic.

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