Histoplasmosis mimicking metastatic carcinoma

A 47-year-old man with a 45-pack-year tobacco history presented to his primary care physician with a 50-lb unintentional weight loss over 3 months, a cough productive of white phlegm, and mouth ulcers. His vital signs were remarkable for the absence of both fever and tachypnea. Physical examination findings were significant for mild cachexia and oral aphthous ulcers.