Acute pulmonary histoplasmosis in a Belgian traveller returning from Suriname diagnosed with NGS: a case report.

We describe the case of a 48-year-old Belgian woman who developed fever, dry cough and dyspnoea shortly after returning from a two-week trip to Suriname. CT scan of the thorax revealed 2 nodular masses with surrounding ground glass alterations in the right lung as well as multiple hilar and mediastinal lymphadenopathies. Bronchoscopy with broncho-alveolar lavage and endobronchial ultrasound-guided transbronchial needle aspiration of thoracic lymph nodes were performed. Broncho-alveolar lavage fluid showed no abnormalities, including a negative PCR for Aspergillus spp., and negative cryptococcal and galactomannan antigen tests. (1→3)-β-D-glucan determination on serum was also negative. Pathological analysis of all punctions showed granulomatous lymphadenitis and the presence of small, rounded structures on Grocott's staining. Fungal identification by targeted nanopore sequencing on lymph node tissue resulted in a weak but specific signal for Histoplasma capsulatum. Our case illustrates the diagnostic value of next-generation sequencing for a rare fungal disease.