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Old 12-16-2012
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Arrow A 43-year-old man with low CD4+

A 43-year-old man from the central United States presents with 6 months of productive cough, intermittent night sweats, and 6.8-kg (15-lb) weight loss. He denies a history of smoking or recent travel outside the United States. The patient’s last CD4+ count 2 weeks ago was 900/mm3 . His temperature is 37.8 °C (100.0 °F); other vital signs and physical exami nation are unremarkable. X-ray of the chest hows a 2.7-cm lesion in the right upper lung field. Stain and cultures are negative for acid-fast bacilli

(A) Adenocarcinoma
(B) Aspergilloma
(C) Cavitating abscess
(D) Histoplasmosis
(E) Mycobacterium tuberculosis infection
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Default Histoplasmosis

DD...histoplasmosis is prevalent in central america but cd4+ of 900 is not low
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Default (B) Aspergilloma

(B) Aspergilloma
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histoplasmosis.......
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(E) Mycobacterium tuberculosis infection
the tests are misleading... I think they could be false negative sense they have low sensitivity and should be repeated in order to increase the sensitivity !
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Histoplasmosis (also known as "Cave disease,"[1] "Darling's disease,"[1] "Ohio valley disease,"[1] "Reticuloendotheliosis,"[1] "Spelunker’s Lung" and Caver's disease)
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The correct answer is H.
Histoplasmosis is endemic in the central United States, specifically around the Mississippi River Valley. Risk factors include AIDS, spelunking, and exposure to bat or bird excrement. Chronic infection is associated with low-grade fever, anorexia, weight loss, night sweats, and productive cough. X-ray of the chest may reveal hilar or mediastinal adenopathy, in addition to a solitary pulmonary nodule or a focal infiltrate. TB and fungi (both histoplasmosis and coccidioidomycosis) are the most frequent causes of infectious granulomas that present as solitary pulmonary nodules. TB is less likely given the negative smear and culture (which can take weeks to complete).

Aspergilloma may manifest as an asymptomatic radiographic abnormality in a patient with preexisting cavitary lung disease due to sarcoidosis, tuberculosis, or other necrotizing pulmonary processes. It is unlikely here due to the lack of history of preexisting cavitary disease.
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