Histoplasmosis with hypercalcemia, renal failure, and papillary necrosis. Confusion with sarcoidosis.

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Abstract
A 56 yr old man with a 3 mo. history of fever, malaise, anorexla, mental confusion and weight loss had hypercalcemia and azotemia. The chest roentgenogram was normal. Biopsy material removed 2 1/2 yr previously showed noncaseating granulomas. Sarcoidosis was diagnosed, and prednisone was administered. Fever persisted, and the patient died 49 days after admission. Postmortem examination showed evidence of extensive disseminated [Histoplasma capsulatum] histoplasmosis, interstitial nephritis and papillary necrosis. This communication emphasizes the difficulty in diagnosing the etiology of disseminated, noncaseating granulomatous disease.