Infectious Diseases

Answer 1 Histoplasmosis. The patient has acute disseminated histoplasmosis. He is an immunocompromised host with a strong exposure history. Histoplasmosis is endemic in the Ohio and Mississippi river valleys and is strongly associated with bird guano. The physical examination findings are consistent with this diagnosis, especially the presence of the palatal ulcer, which is seen in up to 20% of patients with histoplasmosis. Although bacterial pneumonia is a possibility in this patient, the exposure history and physical examination findings are more compatible with histoplasmosis. The seasonality would make influenza unlikely. The patient has no travel history to suggest malaria, and Candida pneumonia is an extremely uncommon diagnosis that can only be made following a lung biopsy with histopathology demonstrating candidal tissue invasion. Click here to return to the questions

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