No abstract

Pulmonary langerhans cell histiocytosis (PLCH) is a diffuse lung disease that primarily affects young adults, with cigarette smoking playing a significant role in developing the disease [1,2]. Patients with PLCH present with characteristic CT chest findings of small irregular nodules and upper zone cysts [3][4][5]. Previously, larger nodules greater than 10 mm and cavitation have only been reported a few times in the literature [6][7][8][9]. We describe the case of a 69-year-old male who presented with dyspnea, non-productive cough and weight loss, who was found to have multiple cavitary nodules on CT imaging of the chest. Histopathologic sampling of the lung revealed Langerhans cells which stained positive for S100 and CD1a, consistent with a diagnosis of PLCH. The patient was counselled to quit smoking as the mainstay of treatment. In 3-month follow-up his symptoms had largely resolved, with evidence of decreased nodule size on repeat CT imaging.

No abstract

Although southern Saskatchewan is not known to be a region endemic to blastomycosis, we present a case of disseminated blastomycosis in a 39-year-old man with pulmonary, genitourinary, and osteoarticular involvement. The patient presented with persistent fevers despite recent antibiotic therapy, arthritis in his left foot, and urinary obstruction. A computed tomography (CT) scan of the chest revealed a diffuse miliary pattern. A transbronchial biopsy only showed granulomatous changes, and washings were negative for fungal culture. Magnetic resonance imaging (MRI) of the left foot revealed signs of septic arthritis. Pathology from the joint aspiration and debridement revealed budding yeast in keeping with blastomycosis. Urine culture also grew blastomycosis, confirming urinary involvement. He was initiated on itraconazole, with complete resolution of his symptoms within 2 weeks. This case illustrates the challenges in diagnosing disseminated blastomycosis, and further establishes the endemicity of blastomycosis in southern Saskatchewan.