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

Published:December 07, 2022DOI:
      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.
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