A 69-year-old female smoker (30 packyears) homemaker from São Sepe, Brazil, presented with rheumatoid arthritis for 14 years. The patient had undergone a thyroidectomy 20 years before. The epidemiological history was not clear regarding possible fungal exposure. The patient had been experiencing progressive dyspnea, productive cough, recurrent respiratory infections, loss of appetite, nausea and weight loss for 4 years. The patient was using levothyroxine, calcitriol and prednisone 15 mg/day; however, she had previously used methotrexate. Physical examination revealed that the patient had lost weight (patient weight at the time was 30 kg, and body mass index was 14 kg/m 2 ). No cervical lymph node enlargement, supraclavic- IntroductionHistoplasmosis is a systemic mycosis caused by the thermally dimorphic fungus Histoplasma capsulatum, which can be isolated from soil contaminated with droppings from birds or bats. (1,2) Similar to other systemic mycoses, the initial exposure is through inhalation, and pulmonary impairment is the predominant form of presentation of the disease. Large outbreaks of the disease have been reported; however, most of the infections are sporadic. (3) Chronic pulmonary histoplasmosis is a rare clinical manifestation of the disease that affects the upper lobes of the lungs and can present as cavitation and fibrosis. (4)(5)(6)(7) We report the case of a female patient with chronic cavitary pulmonary histoplasmosis (CCPH). AbstractHistoplasmosis is a systemic mycosis caused by the thermally dimorphic fungus Histoplasma capsulatum, which can be isolated from soil contaminated with droppings from birds or bats. Chronic cavitary pulmonary histoplasmosis is one of the rarest clinical presentations of this disease. The differential diagnosis with tuberculosis should be made in patients presenting with cavitated lesions in upper lung segments. We report the case of a female patient with chronic cavitary pulmonary histoplasmosis who had presented with progressive dyspnea and worsening of the radiological pattern over a four-year period.Keywords: Histoplasmosis; Cavitation; Pulmonary emphysema. ResumoA histoplasmose é uma micose sistêmica causada pelo fungo dimórfico térmico Histoplasma capsulatum, que pode ser isolado a partir de solo contaminado com excrementos de aves e morcegos. Dentre as apresentações clínicas dessa doença, a histoplasmose pulmonar cavitária crônica (HPCC) é uma manifestação rara. O diagnóstico diferencial com tuberculose deve ser realizado em pacientes que apresentam lesões cavitadas nos segmentos pulmonares superiores. É relatado um caso de uma paciente com HPCC que apresentou dispneia progressiva e piora do padrão radiológico em quatro anos de evolução da doença.