1. History : 24-yr-old woman with chest pain, asthenia and night sweats. She has flown back from Brasilia to France 3 weeks ago. Case of the Month 5 November 2015

2. Case of the Month 5

4. Complete regression of symptoms with paracetamol At the 2-month follow-up: Case of the Month 5 Evolution

5. Case of the Month 5 What is your diagnosis ?

7. History : 24-yr-old woman with chest pain, asthenia and night sweats. She has flown back from Brasilia to France 3 weeks ago. Question : What are the key findings on the CXR? Case of the Month 5 November 2015 Authors: Nicolas HUET Gilbert Ferretti CHU Grenoble, France

8. Pulmonary nodule in the left hemithorax Case of the Month 5

9. Question : What is shown on the CT images? Case of the Month 5

10.  Multiple nodules with small halo of ground-glass attenuation

11. Complete regression of symptoms with paracetamol At the 2-month follow-up: Case of the Month 5 Evolution

12. Case of the Month 5 What is your diagnosis ?

13. Case of the Month 5 Diagnosis Pulmonary histoplasmosis Differential Diagnosis Sarcoïdosis Tuberculosis Pulmonary metastasis Other fungal infection (candidiasis, aspergillosis)

14. Case of the Month 5 Discussion  Pulmonary histoplasmosis is a fungal infection that occurs mainly America, sporadically in Europe.  Infection is caused by breathing in spores of the fungus found in bird and bats droppings.  After an incubation period of 2 weeks, symptoms may be fever, chest pain, dyspnea, cough and hemoptysis but this infection often remains asymptomatic.  Acute phase has a good prognosis, but disseminated forms may occur in infants and immunocompromised patients.  Biological tests (serology, antigenemia, antigenuria) confirm presence of the fungus.

15. Case of the Month 5 Discussion CHEST RADIOGRAPHY  Multiples ill-defined areas of consolidation  Mediastinal enlargement HIGH-RESOLUTION CT  Hilar and mediastinal lymphadenopathy  Multiple or solitary ill-defined nodules  After the acute phase:  Smooth nodules with central calcification  Calcified lymphadenopathy

16. Case of the Month 5 Further Reading Pulmonary Histoplasmosis 1) Guimarães MD et al. Fungal Infection Mimicking Pulmonary Malignancy: Clinical and Radiological Characteristics Lung 2013 Dec;191(6):655-62 2) Chong S et al. Pulmonary fungal infection: imaging findings in immunocompetent and immunocompromised patients Eur J Radiol 2006 Sep;59(3):371-83 3) Gazzoni FF et al. Fungal diseases mimicking primary lung cancer: radiologic- pathologic correlation Mycoses 2014 Apr;57(4):197-208