A previously healthy 21-year-old guy arrives to the office with fever, lethargy, myalgia, and a nonproductive cough. His problems developed two weeks after he returned from touring Missouri caverns. The patient does not smoke, drink alcohol, or use illegal drugs. The temperature is 38.3 C (100.9 F), the blood pressure is 120/70 mm Hg, the pulse rate is 96 bpm, and the respirations rate is 16 /minute. Lung crackles are discovered during a physical examination. An x-ray of the chest reveals patchy parenchymal infiltrates with enlarged mediastinal and hilar lymph nodes. Which of the following is most likely to be present in the pulmonary lesions of this patient?

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Eductional Objective: Histoplasma capsulatum is endemic to the Ohio and Mississippi River valleys and is found primarily in soil contaminated with bird or bat droppings.  It exists in tissues as an ovoid/round yeast predominantly within the intracellular space of macrophages.  Immunocompetent patients are often asymptomatic but can infrequently develop subacute pneumonia with hilar and mediastinal lymphadenopathy.

A Previously Healthy 21-Year-Old Guy Arrives to the Office with Fever