Angelides Philip K, Salamo Oriana, Cherian Sujith V, Guevara Eduardo Yepez, Jimenez Carlos A, Faiz Saadia A
Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA.
Divisions of Pulmonary, Critical Care Medicine and Sleep Medicine, McGovern Medical School at University of Texas Health, TX, USA.
Radiol Case Rep. 2025 May 16;20(8):3836-3839. doi: 10.1016/j.radcr.2025.04.058. eCollection 2025 Aug.
Respiratory infections in patients with cancer are common. A low threshold for bronchoscopy with bronchoalveolar lavage (BAL) should be maintained in immunocompromised patients with pulmonary opacities on chest imaging to evaluate for opportunistic infections. In those with unresolving symptoms, transbronchial biopsies may add significant diagnostic value. Concomitant hypercalcemia in patients with cancer is typically related to underlying malignant disease. However, in those with persistent respiratory symptoms or atypical infiltrates then granulomatous inflammatory diseases should be considered. Diagnosing histoplasmosis in immunocompromised patients can be difficult. Antigen testing is often more sensitive, but tissue biopsy or culture may be needed. We describe a case of histoplasmosis with persistent pulmonary opacities and hypercalcemia diagnosed via transbronchial biopsy, with subsequent clinical and radiographic improvement after treatment.
癌症患者发生呼吸道感染很常见。对于胸部影像学显示肺部有病变的免疫功能低下患者，应保持较低的支气管镜检查及支气管肺泡灌洗（BAL）阈值，以评估是否存在机会性感染。对于症状持续不缓解的患者，经支气管活检可能具有显著的诊断价值。癌症患者合并高钙血症通常与潜在的恶性疾病有关。然而，对于有持续呼吸道症状或非典型浸润的患者，则应考虑肉芽肿性炎症性疾病。在免疫功能低下患者中诊断组织胞浆菌病可能很困难。抗原检测通常更敏感，但可能需要进行组织活检或培养。我们描述了一例通过经支气管活检诊断为组织胞浆菌病且伴有持续肺部病变和高钙血症的病例，治疗后临床及影像学表现均有改善。
