V.N Karazin Kharkiv National University
Internal Medicine
A Case History of acute pulmonary histoplasmosis 35
y.o
Student Name: Mohamed Yousef Gamal Fadlallah
Number of Group: MA-304
Teacher Name: Анна Філатова
Anamnesis
Passport Part
surname: Sophia Martínez
Age: 35 y.o
Sex: female
Family Status: Married
Date of Admission to the Hospital: 16/6/2022
Complaints of the Patient
Cough
shortness of breath
shortness of breath on exertion
Past History
she was seen for similar symptoms previously six months
ago. At that time she was diagnosed with acute bronchitis
and treated with bronchodilators empiric antibiotics, and a
short course oral steroid taper. This management did not
improve her symptoms, and she has gradually worsened
over six months. She reports a (9 kg) intentional weight loss
over the past year
Social History
Her tobacco use is 35 years however she quit smoking
shortly prior to the onset of symptoms six months ago. She
denies alcohol and illicit drug use. She is in a married
Past Medical History: Hypertension
Allergies: No known medicine, food, or environmental
allergies
Past Surgical History: Cholecystectomy
Medications: Lisinopril 10 mg by mouth every day
Vitals: Temperature, 36.5 Celsius; heart rate 88; respiratory
rate, 22; blood pressure 130/86; body mass index, 28
General: She is well appearing but anxious. She is
conversing freely, with respiratory distress causing her to
stop mid-sentence
Respiratory: She has diffuse rales and mild wheezing;
tachypneia
Cardiovascular: She has a regular rate and rhythm with no
murmurs, rubs, or gallops
Gastrointestinal: Bowel sounds X4. No bruits or pulsatile
mass
laboratory diagnosis
pancytopenia with a platelet count of 74,000 per mm3
hemoglobin, 8.3 g per and mild transaminase elevation, AST
90 and ALT 114
Blood cultures were drawn and currently negative for
bacterial growth or Gram staining
Chest X-ray
Impression: Mild interstitial pneumonitis
CT of the chest was performed to further the pulmonary
diagnosis; it showed a diffuse centrilobular micronodular
pattern without focal consolidation
Diagnosis
Based on the bronchoscopic findings, a diagnosis of acute
pulmonary histoplasmosis in an immunocompetent patient
was made.
Treatment
Pulmonary histoplasmosis in asymptomatic patients is selfresolving and requires no treatment. However, once symptoms
develop, such as in our above patient, a decision to treat needs to
be made. In mild, tolerable cases, no treatment other than close
monitoring is necessary. However, once symptoms progress to
moderate or severe or if they are prolonged for greater than four
weeks, treatment with itraconazole is indicated. The anticipated
duration is 6 to 12 weeks.
The patient's response should be monitored with a chest x-ray.
Furthermore, observation for recurrence is necessary for several
years following the diagnosis. If the illness is determined to be
severe or does not respond to itraconazole, amphotericin B should
be initiated for a minimum of 2 weeks, but up to 1 year
Cotreatment with methylprednisolone is indicated to improve
pulmonary compliance and reduce inflammation, thus improving
the work of respiration