Had they been spelunking together? Are they both albinos? I like Jeff's listing of HP and toxic exposures. Though they are related, if they have an acute presentation, similar exposure is more likely to be the culprit rather than similar genetics.
Histo could leave a caseating granuloma which, over time, should calcify. However, if a caseating granuloma is found, in a hypothetical patient with this kind of CXR, I would presume, and treat, for TB until multiple cultures are negative.
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1. HP
2. Crack-lung
3. Some inhalational toxic exposure
4. Talc granulomatosis
5. Viral pneumonia--HSV
6. Disseminated fungal pneumonia
7. Milliary TB
Had they been spelunking together?
Are they both albinos?
I like Jeff's listing of HP and toxic exposures. Though they are related, if they have an acute presentation, similar exposure is more likely to be the culprit rather than similar genetics.
Additional piece of history will be posted later today...good Ddx so far...
Any other takers? Can leave comment anonymous if you want...
Or you can change order of Jeff H's list and take bets....(his list is pretty complete)
Father and son both renovated an old moldy basement.
HISTO Ag - urine 5.4
HISTO AB - H and M bands positive
Final dx: acute pulmonary histoplasmosis.
Interestingly BAL negative.
very intersting story! is it likely that histoplamosis leave a necrotizing-granuloma when the infection heals???
Histo could leave a caseating granuloma which, over time, should calcify. However, if a caseating granuloma is found, in a hypothetical patient with this kind of CXR, I would presume, and treat, for TB until multiple cultures are negative.
If I remember right- more than 5 splenic calcifications are histo unless proved otherwise
Why albinos?
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