A previously healthy 43-year-old man presents with symptoms of cough, fever, weight loss, and lymphadenopathy for the past 2 months. His physical examination reveals multiple axillary and cervical lymph nodes and oropharyngeal ulcerations. His CXR reveals fibronodular pulmonary infiltrates in the apex, his sputum is negative for TB, and the HIV test is negative. A bronchoalveolar lavage (BAL) confirms the diagnosis.For the above patient, select the most likely diagnosis.
Disseminated histoplasmosis has many features in common with hematogenously disseminated TB. Common findings include fever, weight loss, cough, lymphadenopathy, anemia, abnormal liver enzymes, and hepatosplenomegaly. The chronic pulmonary disease is characterized by cough, increasing sputum production, and apical infiltrates. One-third improve or stabilize spontaneously while the remainder progress slowly to develop cavitation of the upper lobes and altered pulmonary function. In histoplasmosis, oropharyngeal ulcerations begin as solitary indurated plaques with no pain present at first, although eventually pain becomes deep-seated. These oropharyngeal manifestations are usually part of disseminated infection.
brucellosis
coccidioidomycosis
histoplasmosis
leprosy
Infection