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A 65-year-old man with cough, hypercalcemia, and diffuse opacities.

Philip K Angelides1, Oriana Salamo2, Sujith V Cherian2

  • 1Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA.

Radiology Case Reports
|June 9, 2025
PubMed
Summary

A low threshold for bronchoscopy is crucial for diagnosing opportunistic infections in cancer patients with pulmonary opacities. This case highlights histoplasmosis diagnosis via transbronchial biopsy, leading to improved outcomes.

Keywords:
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Area of Science:

  • Pulmonology
  • Infectious Diseases
  • Oncology

Background:

  • Respiratory infections are frequent in cancer patients, necessitating prompt diagnosis.
  • Opportunistic infections require a low threshold for bronchoscopy with bronchoalveolar lavage (BAL) in immunocompromised individuals with pulmonary findings.
  • Hypercalcemia in cancer patients usually indicates malignancy, but granulomatous diseases should be considered for persistent respiratory symptoms.

Observation:

  • A case of histoplasmosis presented with persistent pulmonary opacities and hypercalcemia in an immunocompromised patient.
  • Diagnosing histoplasmosis in immunocompromised patients can be challenging, with antigen testing and tissue biopsy/culture being key methods.

Findings:

  • Transbronchial biopsy was instrumental in diagnosing histoplasmosis in this patient.
  • Antigen testing may be more sensitive, but tissue biopsy or culture is often required for definitive diagnosis.

Implications:

  • Early and accurate diagnosis of opportunistic infections like histoplasmosis is vital for effective treatment in immunocompromised cancer patients.
  • Transbronchial biopsy can provide significant diagnostic value for unresolving respiratory symptoms and atypical infiltrates.
  • Considering granulomatous diseases is important in cancer patients with hypercalcemia and persistent respiratory issues.