A Man with Fatigue, Fever, and Hypoxemia

The patient had undergone lung transplantation 15 months earlier, and his explanted lung had shown focal necrotizing granulomas with yeast forms. At the new presentation, he was experiencing low-grade fever and worsening hypoxemia with ambulation. Imaging of the chest showed new lung nodules and enlarging mediastinal lymphadenopathy. Transbronchial biopsy specimens did not show signs of allograft rejection or aspiration, but a fungal culture of bronchoalveolar lavage fluid grew Histoplasma capsulatum after 21 days of incubation (Figure 1).