Night sweats & malaise

A 35-year-old white man, a Tennessee factory worker, was admitted to the hospital on August 30, 1954, because of an illness that had begun 16 days previously. His symptoms had included generalized pain, which had been most marked in the leg muscles, and malaise, fever, weakness, nausea and vomiting, and night sweats. He had lost about lO pounds. Eighteen months previously, he had had a mild, influenza-like illness which had been followed by a persistent, productive cough. The results of the physical examination were not significant.

Roentgenographic examination disclosed dense infiltration of the upper and middle portions of the right lung (figure 1). Repeated cultures of the sputum were positive for Klebsiella pneumoniae, Staphylococcus aureus and Escherichia coli, but cultures of the sputum and bronchial washings were negative for acid-fast bacilli and fungi. The sedimentation rate of the erythrocytes was 34 mm. in one hour.

The histoplasmin skin test and the Mantoux test were positive. A complement-fixation test with H. capsulatum antigen was positive with a low titre, 1:16. A diagnosis of chronic pulmonary infection with K. pneumoniae was made, and antibiotics and GANTRISIN® were administered. The fever persisted for seven days. The patient then improved symptomatically and began to gain weight. The pulmonary infiltration increased, however, in extent and density for one month, but it then decreased with the development of small radiolucent areas. When the pulmonary lesion had persisted for five months, the upper lobe of the right lung was removed. Microscopic examination of the excised lobe disclosed the presence of granulomatous inflammation and necrosis, resembling caseation, in a large cavity and numerous satellite tubercles. Cultures of the pulmonary tissue were positive for H. capsulatum. The patient regained his strength, and his weight returned to normal. He was last seen nine months after the operation. At that time, there was no evidence of pulmonary infection.