An 11-year-old girl presented with a 1-day history of sharp, stabbing chest pain that woke her from sleep. It was intermittently pleuritic and radiated to the left arm. She was otherwise asymptomatic on admission. Her pain resolved hospital day 2, but on hospital day 3 the pain returned, and she developed significant shortness of breath and tachypnea. Vital signs on admission included temperature 98.6°F, pulse 103 bpm, respirations 22, blood pressure 121/71 mm Hg, and oxygen saturation of 100% on room air. Physical examination was benign except for decreased breath sounds over her left lower lobe. On hospital day 3, the patient developed a temperature of 101°F, respirations 33, and a 2 L oxygen requirement. Breath sounds over her left lung progressively decreased. CBC, renal panel, liver functions, amylase, and lipase were completely within normal limits. Other laboratory tests included ESR 3, LDH 379, and alkaline phosphate 313. Initial chest radiography revealed a large mass in the left upper lobe and hilum, deviation of the lower trachea to the contralateral side, and narrowing of the left mainstem bronchus. CT confirmed the mass and noted hilar lymphadenopathy and splenic granulomas. Biopsy and urine antigens came back positive for histoplasmosis. With the diagnosis of histoplasmosis, the patient was started on steroids and itraconazole. Both her pain and her respiratory symptoms quickly improved, and she was discharged home. Pulmonary histoplasmosis and its diagnsosis and treatment will be discussed.
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