A 69-year-old man with chronic lymphocytic leukemia presented with fever and a productive cough. He was diagnosed with a histoplasmosis infection, caused by the dimorphic fungus Histoplasma capsulatum, which is rare in the Netherlands but endemic in parts of the United States and South America. The patient was treated with high doses of itraconazole and gamma globulin infusions. This initially led to a clinical improvement, but eventually he developed a probable progressive histoplasmosis. The patient refused additional treatment and died. In immunocompromised patients, infections of the respiratory tract can be caused by a broad variety of agents. Knowledge of the patient’s travel history is crucial to determine or exclude certain causal agents.