Eisenhower Health, Rancho Mirage, CA, USA.
J Investig Med High Impact Case Rep. 2023 Jan-Dec;11:23247096231197863. doi: 10.1177/23247096231197863.
Cavitary pulmonary coccidioidomycosis is rare diagnosis with an incidence of 13% to 15% of pulmonary coccidioidomycosis cases. High clinical suspicion is necessary in the setting of geographical location endemicity. We present a 49-year-old male who has lived in the Coachella Valley of California for several years, with a medical history of uncontrolled type 2 diabetes who noted 1 week of right-sided chest pain with shortness of breath, fever, chills, night sweats, and weight loss. A chest X-ray revealed a 4- to 5-cm mass in the right lung. Initial workup revealed negative sputum cultures (aerobic/anaerobic, acid-fast bacilli). However, dedicated fungal cultures (samples from sputum, lymph nodes, lung right lower lobe bronchial swabs), bronchial washings, and surgical tissue biopsy of the right lower lobe revealed mold. The patient underwent right thoracotomy with right lower lobectomy and right mediastinal lymph node dissection for both diagnostic (lung specimen) and therapeutic (removing necrotic lung tissue, source control) purposes. Finally, serum antigens were positive and antibody titers were positive at 1:8; surgical biopsy of the right lower lobe grew mold that came back positive for . Targeted pharmacotherapy was commenced using intravenous fluconazole and then oral fluconazole for 3 months was prescribed upon discharge. The patient had gradual improvement of his shortness of breath and was instructed to follow-up at an infectious disease clinic.
肺球孢子菌病空洞性是一种罕见的诊断，其发病率占肺球孢子菌病病例的 13%至 15%。在具有地方性流行的地理位置，需要高度的临床怀疑。我们介绍了一位 49 岁的男性，他在加利福尼亚的科切拉谷生活了数年，有未控制的 2 型糖尿病病史，出现右侧胸痛、呼吸急促、发热、寒战、盗汗和体重减轻 1 周。胸部 X 线显示右肺有 4 至 5 厘米的肿块。初步检查显示痰培养阴性（需氧/厌氧，抗酸杆菌）。然而，专门的真菌培养（来自痰、淋巴结、右下肺支气管拭子的样本）、支气管冲洗和右下肺叶的外科组织活检显示出霉菌。患者接受了右开胸肺下叶切除术和右纵隔淋巴结清扫术，目的是为了诊断（肺标本）和治疗（切除坏死肺组织，控制传染源）。最后，血清 抗原阳性，抗体滴度阳性为 1:8；右下肺叶的外科活检显示出霉菌，对 呈阳性。开始采用静脉氟康唑进行靶向药物治疗，然后在出院时开了 3 个月的口服氟康唑。患者的呼吸急促逐渐改善，并被指示在传染病诊所进行随访。
