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25 May 2020 : Case report  USA

Difficult to Diagnose: An Unusual Cause of Cavitary Lung Lesion

Unknown etiology, Challenging differential diagnosis

Hallie E. Norman1EF, Jonathan M. Davis2ACDEF*, Dipen Kadaria2ABCD

DOI: 10.12659/AJCR.921274

Am J Case Rep 2020; 21:e921274

Abstract

BACKGROUND: Cavitary lung lesions are commonly identified on thoracic imaging, but typically require further workup for definitive diagnosis.

CASE REPORT: Here, we present the case of a 40-year-old Middle Eastern male who presented with an unusual cause of cavitary lung lesion with associated pleural mass and pleural thickening. He underwent bronchoscopic biopsy and computer tomography (CT)-guided core needle biopsy, both of which were non-diagnostic. Surgical biopsy subsequently revealed hyalinized necrotizing granulomatous tissue, consistent with histoplasmosis, and the patient was treated with itraconazole, which he responded well to.

CONCLUSIONS: This case demonstrates the importance of identifying unusual causes of cavitary lung lesions and emphasizes the role of using proper tissue sampling for diagnosis.

Keywords: Biopsy, Histoplasmosis, Lung Diseases, Fungal, Multiple Pulmonary Nodules, Adult, Antifungal Agents, Bronchoscopy, Itraconazole, Lung Diseases, Male, Tomography, X-Ray Computed

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923