It appears that the diagnosis will not be forthcoming, from the pathology findings alone, even as reviewed by the Armed Forces Pathology Lab (AFPL). There are myriad causes of multiple nodules: infectious, such as tuberculosis (TB); fungi; bacterial, such as Nocardia; embolic, such as a blood clot or tumor emboli originating in the heart; hypersensitivity diseases, such as hypersensitivity pneumonitis (HP); auto-immune diseases, such as Wegener's Granulomatosis; and tumors, benign and malignant.
Apparently the last of these tumors have been ruled out but not necessarily old or current infection. That would require cultures for bacteria, fungi and TB.
The temporal relationship between your company's move into a new office in October and the onset of symptoms in November cannot be ignored, even allowing that the two may not be related. However if they are, then everything must be cultured including your sputum, any lung biopsy tissue that was preserved, and the heating and cooling systems in your office. The finding of multiple nodules with inter-nodular normal lung tissue would argue against infection, such as Legionella or fungi, but not necessarily against Mycobacterium tuberculosis (TB) or nontuberculous mycobacterial infection. The same could be said for HP, called extrinsic allergic alveolitis, but such strange presentations sometimes do occur, albeit rarely.
The key action, at this time, is to look carefully at the relation between your disease and your work environment and this investigation may benefit from consultation with an industrial hygienist. Were another employee to develop similar signs and symptoms that too would strongly suggest an environmental cause.
Please give us a follow-up to let us know how you are doing.
. Thank you for your response. I received a call from my surgeon yesterday afternoon, the samples came back positive for both histoplasmosis and silicosis (I have an appointment this afternoon with my Pulmonologist). From what the surgeon said these are new, active conditions and they will want to treat the histoplasmosis with an anti-fungal med. I hope to learn more about the timing of both of these. I'm even more curious about the work connection with the histoplasmosis now. I live in the Tampa Bay area of Florida - not an area usually connected with this. However, in the journal I've kept from the beginning of this shows that the first week in December the building management company cleaned all the plants (an atrium type set-up with a three story opening in the center, I am located on the third floor). It was shortly after that I began getting sick. Also, I have Beau's lines on more than half of my nails that tie into the same time line.
As for the Silicosis, I have no idea where I would have been exposed to that. I have never been in an occupation (or hobby) that is connected with Silica dust.
Are you aware of any connection between histoplasmosis and silicosis? How can I locate an environmental hygienist?
Again, thank you for your time and advice.