A 61-year-old farmer was hospitalised three days after the sudden onset of spontaneous pneumothorax. The first evidence of pulmonary disease had occurred six years and three months previously. A roentgenographic examination had disclosed a minimal lesion in the apex of the left lung. A diagnosis of cystic disease of both lungs had been made. The patient had been hospitalised for the second time for Loss of weight, fatigue on mild exertion, dyspnoea, cough, and purulent sputum had continued to occur. On the third admission, the patient was acutely ill. Severe dyspnoea was evident, but cyanosis was not present. The left side of the thorax was contracted. Hyperresonance was present over the right side of the chest, and distant breath sounds were heard at the base of the right lung. Expiration was prolonged, and many rales were heard bilaterally.
Investigations: - Roentgenographic examination revealed a pneumothorax at the base of the right lung and dense infiltration and small radiolucent areas in the apex of this lung. The left side of the thorax was contracted, and the heart, mediastinum and trachea were displaced to the left. A serologic test with H. capsulatum antigen was positive with a low titer, 1:32. The histoplasmin skin test and the Mantoux test were positive. The sedimentation rate of the erythrocytes was 39 mm. in one hour. The value for the total serum protein was elevated, and the albumin globulin ratio for the serum was reversed.
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