Photo Quiz: You Get What You Get, and Sometimes It's Tuberculate.

Abstract

A 30-year-old woman with unmanaged HIV moved to the United States from Cameroon in west-central Africa 2 years prior to her presentation at a hospital in New Jersey. She had not traveled outside of the northeastern region of the United States over the 12 months prior to presentation. The patient arrived at the emergency department in respiratory distress with nonproductive cough, fever, and headache. Over the previous 2 weeks, she had fever, abdominal pain, nausea, and vomiting. A chest computerized tomography (CT) scan showed diffused infiltrates, described to have “ground glass” opacities. The differential was broad at the time of presentation and included workup for typical and atypical community-acquired pneumonia of both bacterial and viral etiologies as well as tuberculosis and nontuberculous mycobacteria and fungal etiologies. Upon admission, the patient’s CD4+ T cell count was less than 100 cells/mm3, elevating the concern regarding a disseminated infection. An extensive workup was negative for all noninfectious and infectious causes of disease over the first few days of hospitalization, with the exception of yeast seen inside the white blood cells in the peripheral blood smear. The fungal culture from a lymph node later grew the organism shown in Fig. 1.