Bilateral pleural masses in an immunocompromised patient

• Published in: BMJ case reports Vol. 13; no. 11; p. e237696
• Main Authors: Patel, Sachin R, Foroughi, Maryam, Nasser, Wael, Khan, Rumi
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 04.11.2020; BMJ Publishing Group
• Series: Case report
• Subjects: Aged; Antigens; Biopsy; Bronchoscopy; Case reports; Fever; Fungal infections; Granulomas; Humans; Immunocompromised Host; Lavage; Lung Diseases, Fungal - complications; Lung Diseases, Fungal - diagnosis; Lung Diseases, Fungal - microbiology; Male; Microscopy; Pathogens; Pathology; Patients; Pleura - diagnostic imaging; Pleura - surgery; Pleural Diseases - diagnosis; Pleural Diseases - etiology; Pleural Diseases - surgery; Pneumocystis carinii - isolation & purification; Pneumonia; Pneumonia, Pneumocystis - complications; Pneumonia, Pneumocystis - diagnosis; Pneumonia, Pneumocystis - microbiology; Reminder of Important Clinical Lesson; Sarcoidosis; Thoracoscopy; Tomography, X-Ray Computed; Tuberculosis; pleural infection; cardiothoracic surgery; pathology; pneumonia (respiratory medicine); medical education
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-237696

We present a case of persistent pleural masses with mediastinal adenopathy in an immunocompromised patient initially biopsied, diagnosed and treated for Pneumocystis jiroveci pneumonia, ultimately requiring surgical thoracoscopy to diagnose pulmonary histoplasmosis. We discuss the diagnostic approach for pleural masses in immunocompromised patients, the limitations of tissue sampling, interpretation and methodology, and pitfalls of testing in making a pathogen-specific diagnosis.