Correct!
3. Treat with itraconazole
We were uncertain if the clinical picture represented active histoplasmosis (1). About a third of patients with active histoplasmosis have a complement fixation titer for yeast of only 1:8 or 1:16. We thought that the patient most likely had smoldering histoplasmosis and was developing fibrotic scarring in her perihilar region. This would be similar to fibrosing mediastinitis from histoplasmosis (2). We were reluctant to treat with corticosteroids given her positive histoplasmosis complement fixation test, and therefore, treated her with itraconazole. Her cough quickly improved and a repeat thoracic CT shows the hilar mass and the lung lesions to be smaller in size. There are plans for close clinical and radiologic follow up.
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