A 21-Year-Old Previously Healthy Man Comes to the Office Due

A 21-year-old previously healthy man comes to the office due to fever, malaise, myalgia, and nonproductive cough.  His symptoms began 2 weeks after returning from exploring caves in Missouri.  The patient does not use tobacco, alcohol, or illicit drugs.  Temperature is 38.3 C (100.9 F) , blood pressure is 120/70 mm Hg, pulse is 96/min, and respirations are 16/min.  Physical examination reveals lung crackles.  Chest x-ray shows patchy parenchymal infiltrates with enlarged mediastinal and hilar lymph nodes.  Which of the following is most likely to be present in this patient's pulmonary lesions?

A) Budding yeasts with a thick capsule
B) Macrophages with intracellular small yeasts
C) Round spherules with multiple endospores
D) Septate hyphae with dichotomous branching
E) Yeasts with pseudohyphae and blastoconidia

Correct Answer:

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