title: [Progressive malaise and joint pain after travel to Costa Rica].
abstract: METHODS
  We report on a 57-year-old patient presenting with progressive malaise, joint pain and skin rashes one month after visiting Costa Rica. After exclusion of common tropical diseases empiric antibiotic therapy was initiated, however, the patient's symptoms did not improve.
  
  
  METHODS
  CT scan of the chest demonstrated an intrapulmonary nodular lesion. Bronchoscopy revealed no pathological changes. Microbiologic analysis of the bronchoalveolar lavage fluids identified no pathogen. An abdominal ultrasound examination did not reveal pathological findings. Serological tests were positive for Histoplasma capsulatum.
  
  
  METHODS
  Treatment with itraconazole resulted in a fast initial clinical improvement, but complete resolution of all symptoms only occurred after completion of a 6-months course of itraconazole. Serial CT scans demonstrated a continuous regression of the pulmonary lesion.
  
  
  CONCLUSIONS
  Histoplasmosis has a low incidence among travelers. However, histoplasmosis should be considered in patients with respiratory symptoms and history of travel to endemic countries, specifically when common traveler diseases have been excluded. Diagnosis is confirmed by serology, imaging and ultimately by biopsy for histological, cultural and molecular identification of the pathogen. Antimycotic drug therapy is the recommended treatment of choice for symptomatic cases.
authors.affiliation: Institut für Tropenmedizin, Reisemedizin und Humanparasitologie, Universitätsklinikum Tübingen.
authors.forename: Jonas
authors.initials: J
authors.lastname: Ehrhardt
authors.forename: Kathrin
authors.initials: K
authors.lastname: Tintelnot
authors.forename: Peter
authors.initials: P
authors.lastname: Kremsner
authors.forename: Matthias
authors.initials: M
authors.lastname: Frank
mesh_terms: D000818:Animals; D018771:Arthralgia / Q000209:etiology*; D002685:Chiroptera / Q000382:microbiology; D003364:Costa Rica; D003906:Developing Countries; D003937:Diagnosis, Differential; D005221:Fatigue / Q000209:etiology*; D006658:Histoplasma; D006660:Histoplasmosis / Q000175:diagnosis* / Q000635:transmission; D006801:Humans; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000635:transmission; D008297:Male; D008875:Middle Aged; D014195:Travel