WHEN ANTIBIOTICS DONT WORK, TIME TO THINK BEYOND BACTERIUM. S. Malhi1 1 , K. Gopal 1 ; 1 Fairview Hospital, Fairview Park, OH LEARNING OBJECTIVES: 1) Work up of non resolving pulmonary infiltrate. 2) Recognize the clinical manifestations of Disseminated Histoplasmosis. 3) Suspecting HIV disease in the presence of opportunistic infection CASE INFORMATION: A 54 yrs. old white male presented to the ER with complaint of fever, shaking chills, myalgias, fatigue, and episodes of profound sweating. He had been sick for the past 4 weeks. His primary care physician ordered a chest radiograph that revealed an infiltrate & he was treated with Levofloxacin for 10 days. Patient continued to do poorly with fevers in the range of 100 ± 104 F and was then treated with another 7 ± 10 days of antibiotics. He lost 20 lb. of weight and hence presented to the ER. His other medical problems included hypertension and remote history of alcohol abuse. He denied smoking, current alcohol or drug use. He was divorced, had 3 children and worked as a social worker. Physical exam was remarkable for a fever of 102 F and mild tachycardia. A CXR on admission showed worsened left lung infiltrate. Initial Lab studies revealed WBC 3.0, HGB 11.0, HCT 31.8, MCV 81, PLT 192 DISCUSSION: A lung biopsy may be the last recourse to obtain a diagnosis and ascertain the correct treatment for a non resolving pulmonary infiltrate. Disseminated Histoplasmosis occurs in elderly and about 5% of AIDS patients in endemic areas and is characterized by fever, malaise, pulmonary infiltrates, hepatosplenomegaly, lymphadenopathy and weight loss. Where as asymptomatic infection is most common; CXR of patients with acute infection show focal mid lung infiltrates (30%), hilar or mediastinal lymphadenopathy (30%) or both (30%).