A 60-year-old female, known case of rheumatoid ahritis presented to the ER with shoness of breath, fever and cough for 2 days. Patient was staed on infliximab 2 months ago. On examination, Hypotension Hypoxemic Not maintaining spO2 on room air. Patient was diagnosed with respiratory failure and put on mechanical ventilation. Bronchioalveolar lavage was done and subjected to silver staining. Chest x-ray What is the most likely diagnosis in the above condition: -
High-Yield Explanation
This is a case of Histoplasmosis. X-ray shows B/L interstitial infiltrates. Silver staining shows the budding yeast forms of Histoplasma capsulatum. Patient on infliximab/ other anti TNF therapies have risk of: - MTB Histoplasma Pneumocystis Legionella CMV Disseminated histoplasmosis presents as: - Respiratory failure Pancytopenia DIC Multiorgan failure