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Case report
Bilateral pleural masses in an immunocompromised patient
  1. Sachin R Patel1,2,
  2. Maryam Foroughi3,
  3. Wael Nasser2,4 and
  4. Rumi Khan2,4
  1. 1Pulmonary Disease/Critical Care Medicine Fellowship Program, Orlando Regional Medical Center, Orlando, Florida, USA
  2. 2Office of Faculty and Academic Affairs, University of Central Florida College of Medicine, Orlando, Florida, USA
  3. 3Department of Pathology, Orlando Regional Medical Center, Orlando, Florida, USA
  4. 4Pulmonary/Critical Care & Sleep Medicine, Orlando Regional Medical Center, Orlando, Florida, USA
  1. Correspondence to Dr Sachin R Patel; sachin.patel{at}


We present a case of persistent pleural masses with mediastinal adenopathy in an immunocompromised patient initially biopsied, diagnosed and treated for Pneumocystis jiroveci pneumonia, ultimately requiring surgical thoracoscopy to diagnose pulmonary histoplasmosis. We discuss the diagnostic approach for pleural masses in immunocompromised patients, the limitations of tissue sampling, interpretation and methodology, and pitfalls of testing in making a pathogen-specific diagnosis.

  • pneumonia (respiratory medicine)
  • cardiothoracic surgery
  • pleural infection
  • pathology
  • medical education

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  • Contributors SP, principal author, made substantial contributions to study conception and design, and/or acquisition of data, and/or analysis and interpretation of data, drafting and final revision of manuscript. MF, second author, made contributions to pathology imaging, descriptions of pathology and reviewing drafts. WN, third author, made contributions by reviewing imaging, sources, acquiring consent from patient, references and reviewing drafts for multiple revisions for flow, organisation and tone of manuscript. RK, fourth author, made significant contributions to drafting and final revision of manuscript for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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