A 43-Year-Old Man with a Pulmonary Nodule

A 43-year-old man, originally from northern South America and living in Panama, underwent evaluation at Massachusetts General Hospital following incidental discovery of a 14 mm FDG-avid pulmonary nodule in the right middle lobe. He was asymptomatic and had a strong family history of cancer. Multidisciplinary diagnostic workup—including CT, PET, and tissue biopsy revealed necrotizing granulomatous inflammation with fungal organisms consistent with Histoplasma capsulatum. Despite negative antigen tests, antibody titers confirmed histoplasmosis. No treatment was recommended due to the localized nature and absence of systemic illness. Follow-up imaging showed reduction in nodule size, and the patient remains under observation. The case highlights diagnostic challenges of endemic fungal infections mimicking malignancy, and underscores the utility of integrated Pulmonary Nodule Clinics in managing such findings.

A 43-year-old man, originally from northern South America and living in Panama, underwent evaluation at Massachusetts General Hospital following incidental discovery of a 14 mm FDG-avid pulmonary nodule in the right middle lobe. He was asymptomatic and had a strong family history of cancer. Multidisciplinary diagnostic workup—including CT, PET, and tissue biopsy revealed necrotizing granulomatous inflammation with fungal organisms consistent with Histoplasma capsulatum. Despite negative antigen tests, antibody titers confirmed histoplasmosis. No treatment was recommended due to the localized nature and absence of systemic illness. Follow-up imaging showed reduction in nodule size, and the patient remains under observation. The case highlights diagnostic challenges of endemic fungal infections mimicking malignancy, and underscores the utility of integrated Pulmonary Nodule Clinics in managing such findings.