Miliary Histoplasmosis Mimicking Miliary Tuberculosis in a Patient Treated with Tumor Necrosis Factor-α Inhibitor Therapy.

In patients receiving anti–tumor necrosis factor (TNF)-α agents, a miliary pattern on chest imaging is often attributed to tuberculosis. However, fungal infections (histoplasmosis, blastomycosis, and coccidioidomycosis) and metastatic pulmonary disease should also be considered1,2.\n\nA 40-year-old woman, diagnosed with ankylosing spondylitis, was in remission with adalimumab. She presented with a 3-week history of fever, night sweats, dyspnea, and dry cough. She reported exposure to demolition dust …