PMC9280390_01
CT chest images from the initial and subsequent hospital presentations. (a) and (b) show CT scan without contrast performed during the patient's initial presentations demonstrating pulmonary nodules in the left and right upper lobes with blue and green circles, respectively, and a left pulmonary nodule at the base of the left lung with red circle. (c) and (d) show CT scan without contrast performed one month after the patient's initial consultation demonstrating similar pulmonary nodules to her preliminary visit with nodules identified by the same color circle as in (a) and (b).
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fig1
With positive CMV respiratory viral cultures, recurrent fevers, and ground glass opacities on the CT from her initial presentation, (Figures 1(a) and 1(b)), CMV pneumonitis was suspected and she was then started on valganciclovir 900 mg twice daily. Computed tomography (CT) of the chest showed innumerable small pulmonary nodules throughout both lungs, many demonstrating a peri lymphatic distribution (Figures 1(c) and 1(d)).
Temperature response to the initiation of antifungal therapy. Graph of the patient's temperature throughout until her final consultation to the hospital and diagnosis of disseminated histoplasmosis. This graph shows the patient's temperature throughout her final hospitalization. Each dose of IV ganciclovir and IV amphotericin are indicated by gray and orange dots, respectively.
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fig2
Given this result in the context of a compatible clinical picture, she was diagnosed with disseminated histoplasmosis, and treatment was started with liposomal amphotericin B at 3 mg/kg per day, followed by rapid resolution of her fever and symptoms (Figure 2).