Disseminated Histoplasmosis: An Unusual Finding at ROSE

We describe an unusual case in which disseminated histoplasmosis was suspected at the time of of rapid on-site assessment (ROSE) performed during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). The patient was a renal transplant recipient with fever, mild anemia, bilateral lung infiltrates and mediastinal lymphadenopathy who underwent EBUS-TBNA of station 11L and 7 lymph nodes. The diagnosis of disseminated histoplasmosis was suggested at the time of ROSE and confirmed several days later by microbiologic cultures. Cytomorphologic findings on routine stains can be a powerful clue to the disseminated form of histoplasmosis.