Histoplasma capsulatum: een zeldzame oorzaak van interstitiële nefritis

A 46-year-old Brazilian man, smoker with a 10-pack-year history and a social drinker, was referred to nephrology for evaluation of elevated serum creatinine (2.2 mg/dl; baseline 0.9 mg/dl 6 months earlier). He had been followed by pulmonology for an 8-month history of malaise, intermittent fever, unintentional weight loss of 20 kg over 2 months, oral ulcers, and a chest computed tomography showing hilar lymphadenopathy and centrilobular nodules with a tree-in-bud pattern in the left lobe. Bronchofibroscopy with lung biopsy revealed lymphocytes, plasma cells, foamy histiocytes, multinucleated giant cells, and granulomas, with no fungi or mycobacteria (negative Grocott and Fite-Faraco stains), consistent with sarcoidosis.