Generally self-limited but can disseminate in certain patients on TNF alpha blockers. Sx: low-grade fevers, wt loss, night sweats, lymphadenopathy. Rarely, hypercalcemia can be seen attributed to increased production of 1,25 dihydroxy vitamin D in the granulomas
Hypercalcemia was not mediated by PTH given ⬇️level. With his constellation of sx+mediastinal lymphadenopathy:
- DDx:
- malignancy (PTHrP neg though in this pt)
- Granulomatous inflammation
- 1,25dihydroxy vitD & 25vitD D usually ⬆️ with sarcoidosis, histoplasmosis, TB
Sensitivity of the urine Histoplasma antigen is higher in more severe disease as well as in immunocompromised patients. Better sensitivity when Serum and urine histo antigens are both sent.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3588607/
https://www.amjmedsci.org/article/S0002-9629(20)30414-6/fulltext
https://casereports.bmj.com/content/12/8/e231142
Originally tweeted by Indiana University Infectious Diseases Fellowship (@IUIDfellowship) on 9 January, 2021.