title: Lesson of the month 1: Lobar pulmonary consolidation in an immunocompromised host.
abstract: A 19-year-old male with a history of idiopathic panuveitis, currently taking methotrexate and infliximab, presented to our institution with 6 weeks of cough, dyspnoea and fevers. He had failed outpatient antimicrobial therapy. Computerised tomography (CT) of the chest revealed the presence of a lobar pneumonia and he was treated with broad spectrum antibiotics, which did not improve his symptoms. Bronchoalveolar lavage was performed with a transbronchial lung biopsy because of the diagnostic uncertainty of the patient's presentation. Pathology revealed non-budding yeasts, consistent with Pneumocystis Serological and urine studies were positive for both Histoplasma and Blastomyces The diagnosis of Histoplasma pneumonia was made because of the presentation being inconsistent with Pneumocystis pneumonia, and serology, urine and pathology testing being more consistent with Histoplasma The patient was treated with oral itraconazole and was doing well at follow-up 12 weeks after hospitalisation.
authors.affiliation: Mayo Clinic, Rochester, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Reynolds
authors.affiliation: Mayo Clinic, Rochester, USA.
authors.forename: Carl A
authors.initials: CA
authors.lastname: Andersen
authors.affiliation: Mayo Clinic, Rochester, USA.
authors.forename: Sumedh S
authors.initials: SS
authors.lastname: Hoskote
authors.affiliation: Mayo Clinic, Rochester, USA.
authors.forename: Hee Eun
authors.initials: HE
authors.lastname: Lee
authors.affiliation: Mayo Clinic, Rochester, USA.
authors.forename: Aditya
authors.initials: A
authors.lastname: Raghunathan
authors.affiliation: Mayo Clinic, Rochester, USA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kalra
authors.affiliation: Mayo Clinic, Rochester, USA.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Limper
mesh_terms: D000328:Adult; D006660:Histoplasmosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000382:microbiology; D006801:Humans; D016867:Immunocompromised Host; D008168:Lung / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D008297:Male; D055815:Young Adult
keywords: Blastomyces; Histoplasma; Pneumocystis; fungi; immunosuppression; pneumonia