Acute pulmonary histoplasmosis (APH) typically presents with fever, chills, shortness of breath, and resembles community acquired pneumonia. APH can range from a mild self-limiting illness to acute respiratory distress syndrome. Subacute pulmonary histoplasmosis (SPH) has a more insidious onset over at least one month and may develop after a smaller inoculum exposure. Chronic pulmonary histoplasmosis (CPH) is classically seen in older males with underlying lung disease. CPH has a similar presentation to tuberculosis with fever, night sweats, weight loss, cough, and dyspnea over at least three months. H capsulatum may also cause pulmonary nodules, mediastinal adenitis, mediastinal granulomas, and mediastinal fibrosis. Progressive disseminated histoplasmosis is a form of histoplasmosis that result from hematogenous spread and can impact multiple organ symptoms including the respiratory tract and cause severe disease.