Am Rev Respir Dis
- Goodwin Rajr, Rm Desprez, Histoplasmosis
- Am Rev Respir Dis
The patient, a 48-year-old Irish engineer, was admitted to hospital on 6 December 1978. He complained of dry cough and intermittent sweating for six weeks. There were no other symptoms. He stopped smoking cigarettes six years before admission and was a pipe smoker until this illness. A considerable portion of his life had been spent in the tropics. In 1945-50 he was in Malaya for 12 months; in 1957-58 he was in Nigeria for 12 months; in 1958-59 he was in Senegal for nine months; in 1959-60 he was in Malta for nine months; in 1969-70 he was in Zambia. In 1973 he returned to Ireland and has lived here since. On examination he was a fit looking man. There was no lymphadenopathy. Blood pressure was 130/90. A soft systolic murmur at the lower left sternal edge was noted. The lungs were clinically clear. He had normal breath sounds over both lungs and no added sounds. The abdomen, genitalia and nervous system were normal on examination. Chest radiography showed multiple discrete opacities in both mid and lower zones (fig 1). The erythrocyte sedimentation rate was 63 mm in one hour. The Mantoux test was positive. Pulmonary function tests showed a mild restrictive defect. Peripheral lung biopsy showed interstitial fibrosis. Other investigations including full blood count, urea and electrolytes, electrocardiograph, intravenous pyelogram, liver biopsy, and bronchoscopic appearances were normal. A left basal segmentectomy was carried out on 18 December 1978.