A 30-year-old woman comes to the physician because of a dry cough and chest discomfort for the past 3 days. During this period, the patient has had headaches, muscle aches, joint pain, fever, and chills. Ten days ago, she was hiking with her family in Mississippi. The patient has asthma that is treated with an albuterol inhaler. Her mother has a lung disease treated with methotrexate. The patient has smoked one pack of cigarettes daily for the past 10 years. Her temperature is 38°C (100.4°F). Physical examination shows slight wheezes throughout both lung fields. Chest imaging shows several small calcified nodules in both lungs and a calcified mediastinal lymph node. Urinalysis is positive for a polysaccharide antigen. Tuberculosis skin test shows a

Question

A 30-year-old woman comes to the physician because of a dry cough and chest discomfort for the past 3 days. During this period, the patient has had headaches, muscle aches, joint pain, fever, and chills. Ten days ago, she was hiking with her family in Mississippi. The patient has asthma that is treated with an albuterol inhaler. Her mother has a lung disease treated with methotrexate. The patient has smoked one pack of cigarettes daily for the past 10 years. Her temperature is 38°C (100.4°F). Physical examination shows slight wheezes throughout both lung fields. Chest imaging shows several small calcified nodules in both lungs and a calcified mediastinal lymph node. Urinalysis is positive for a polysaccharide antigen. Tuberculosis skin test shows a <5 mm induration at 48 hours. Which of the following is the most likely cause of the observed findings in this patient?

Quizplus · Accepted Answer

Eductional Objective: Histoplasma capsulatum replicates within macrophages and often spreads from the lungs through the pulmonary lymphatics to the reticuloendothelial system (eg, spleen, liver).  Most healthy individuals quickly contain the infection within granulomas and do not become ill; a minority develop self-limited pneumonia.  Over time, the granulomas at the initial sites of infection calcify and may be seen incidentally on radiographic imaging.

A 30-Year-Old Woman Comes to the Physician Because of a Dry