An adolescent with asthma presenting with worsening cough.

The diagnosis of systemic histoplasmosis may be delayed due to underlying pulmonary conditions in patients from an endemic area. An adolescent White male from the Midwestern United States with a history of moderate persistent asthma presented to the pulmonary clinic with a 10-day's history of cough. The patient had no response to modifications of his asthma treatment regimen and proceeded to experience worsening symptoms, including pleuritic chest pain and dysphagia.