Advertisement

Fever of Unknown Origin Secondary to Pulmonary Histoplasmosis in Scleroderma-Related Interstitial Lung Disease

Published:December 07, 2022DOI:https://doi.org/10.1016/j.amjmed.2022.11.018
      A Caucasian male in his mid-50s presented to a community hospital in fall 2020 with a 1-month history of nonproductive cough, nausea, vomiting, chills, and nightly fevers greater than 40°C with associated diaphoresis. His past medical history included limited-cutaneous systemic sclerosis (Lc-SSc) diagnosed 5 years prior, SSc-related interstitial lung disease (SSc-ILD), dyslipidemia, osteoporosis, nephrolithiasis, and gastroesophageal reflux. His interstitial lung disease was diagnosed 2 years prior to presentation, and he was responding well to mycophenolate mofetil and oral low-dose prednisone daily. Most recent pulmonary function test showed a forced expiratory volume in 1 second to forced vital capacity ratio of 85%, forced expiratory volume in 1 second of 2.43 L or 74% predicted, total lung capacity 3.89 L or 60% predicted, and a diffusion capacity of 27% predicted. There was no history of recent travel, and the patient was a lifetime nonsmoker with no alcohol use. He was working as a cemetery caretaker with direct soil exposure, but there was no history of similar illness among his coworkers. He was prescribed azithromycin and moxifloxacin in the community for a presumed pneumonia.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Walsh TJ
        • Hayden RT
        • Larone DH.
        Larone's medically important fungi: a guide to identification.
        6th ed. ASM Press, Washington, DC2018
        • Arauz AB
        • Papineni P.
        Histoplasmosis.
        Infect Dis Clin N Am. 2021; 35: 471-491
        • Fang W
        • Washington L
        • Kumar N.
        Imaging manifestations of blastomycosis: a pulmonary infection with potential dissemination.
        Radiographics. 2007; 27: 641-655https://doi.org/10.1148/rg.273065122
        • Wheat LJ
        • Freifeld AG
        • Kleiman MB
        • et al.
        Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America.
        Clin Inf Dis. 2007; 45: 807-825https://doi.org/10.1086/521259
        • Chapman SW
        • Dismukes WE
        • Proia LA
        • et al.
        Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America.
        Clin Inf Dis. 2008; 46: 1801-1812https://doi.org/10.1086/588300