Miliary Patterns on Computerized Tomography Imaging of Chest in Immunocompromised Patient: Unveiling Disseminated...

Area of Science:

• Mycology
• Infectious Diseases
• Immunology

Background:

• Disseminated histoplasmosis, caused by Histoplasma capsulatum, is rare and typically affects immunocompromised individuals.
• Immunocompetent hosts usually experience asymptomatic or self-limiting disease.
• Atypical presentations in immunocompromised patients can delay diagnosis.

Purpose of the Study:

• To report a case of disseminated histoplasmosis with miliary pattern in an immunocompromised host.
• To highlight diagnostic challenges and atypical imaging findings.
• To emphasize the importance of early diagnosis and appropriate treatment.

Main Methods:

• Case report of a patient with shortness of breath, cough, fever, and weight loss.
• Computed tomography (CT) of the chest revealed miliary disease.
• Histoplasma antigen tests (urine and bronchoalveolar lavage) were positive.
• CT of the abdomen/pelvis showed splenic and adrenal lesions.

Main Results:

• Diagnosis of miliary disseminated histoplasmosis confirmed.
• Initial presentation mimicked tuberculosis, causing diagnostic delay.
• Patient treated with amphotericin B followed by itraconazole.

Conclusions:

• Disseminated histoplasmosis requires high suspicion in immunocompromised patients, particularly those on tumor necrosis factor inhibitors.
• Definitive diagnostic tests like culture and histopathology are essential, even if antibody detection is negative.
• Prompt diagnosis and treatment are critical to reduce high mortality rates.