Case 2

A 10-YEAR-OLD boy from Arkansas was admitted to the hospital with a history of fever and hacking cough of 7 days' duration. Two weeks before admission, the patient had helped his father (who developed a similar illness) to raze an old building and remove dirt from the site to their home to make several flower beds. The present illness included anorexia, lethargy, vomiting, and weight loss. His medical history was remarkable for a reactive purified protein derivative skin test 3 years earlier following exposure to an uncle with active tuberculosis. The chest roentgenogram was normal then and the patient had received isoniazid prophylaxis for 6 months. Frontal and lateral chest roentgenograms were obtained on admission (Figure).

Denouement and Discussion 

Miliary Pulmonary Histoplasmosis in an Immunologically Normal Child  Histoplasmosis complement fixation titers were 1:64 and 1:32 for the mycelial and yeast phases, respectively. Immunodiffusion titers were negative. Several weeks later, cultures