Bronchopleural fistula and lymphocytic empyema due to Histoplasma capsulatum

A patient presented with chest pain, fever, and chills and developed a large pleural effusion while receiving antibiotic therapy. On a CT scan of the chest, multiple loculi of fluid were noted, and at surgery, a complex empyema with an associated bronchopleural fistula related to a granulomatous process in the lower lobe of the right lung was demonstrated. Cultures revealed Histoplasma capsulatum in the pleural fluid as well as in the pulmonary parenchymal process.