Acute Pulmonary Histoplasmosis Presenting as Adult Respiratory Distress Syndrome

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Abstract
Three patients with acute pulmonary histoplasmosis presented with extensive, diffuse bilateral infiltrates on chest roentgenograms. Fungal elements were seen in the bronchial secretions of 2 patients; Histoplasma capsulatum was grown from sputum from the 3rd patient and from soil from the patients'' workplace. Two patients were severely hypoxemic and required short courses of amphotericin B therapy; in 1 of these 2, progressive deterioration dictated corticosteroid therapy as well, with a dramatic clinical response. Radiologic resolution of disease occurred more quickly in the treated patients. Initial pulmonary function tests suggested mild restriction in each, with normal test results by the 4th mo. of follow-up. Amphotericin B may shorten the course of acute histoplasmosis and corticosteroid therapy may be efficacious in controlling the symptoms related to hyperresponsiveness in fulminant primary disease.

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