We presented a 49 year old female with intermittent fevers for 7 days as high as 103F. She had been diagnosed with a sinus infection 6 weeks prior to presentation but did not improve with treatment. She had a history of rheumatoid arthritis and was on Enbrel and MTX. At outside hospital she was noted to have elevated LFTs and CRP. Initial work up was unrevealing for cause and she had continued fevers prompting specialized work up, her urine and serum histo returned positive as did her BAL when she was intubated for hypoxia. Unfortunately, despite treatment with ampho B she passed away due to multi-organ failure resulting from disseminated histoplasmosis.