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March 28, 1977

Histoplasmosis With Hypercalcemia, Renal Failure, and Papillary Necrosis: Confusion With Sarcoidosis

Author Affiliations

From the Nephrology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, NY.

JAMA. 1977;237(13):1350-1352. doi:10.1001/jama.1977.03270400054019

A 56-year-old man with a three-month history of fever, malaise, anorexia, mental confusion, and weight loss had hypercalcemia and azotemia. The chest roentgenogram was normal. Biopsy material removed 2 1/2 years previously showed noncaseating granulomas. Sarcoidosis was diagnosed, and prednisone was administered. Fever persisted, and the patient died 49 days after admission. Postmortem examination showed evidence of extensive disseminated histoplasmosis, interstitial nephritis, and papillary necrosis. This communication emphasizes the difficulty in diagnosing the etiology of disseminated, noncaseating granulomatous disease.

(JAMA 237:1350-1352, 1977)