Kattamuri Lakshmi, Zambrano Angelica, Duvvuru Sparsha Reddy, Sharma Kunal, Deoker Abhizith
Texas Tech University Health Sciences Center El Paso, USA.
Paul L. Foster School of Medicine, El Paso, TX, USA.
J Investig Med High Impact Case Rep. 2025 Jan-Dec;13:23247096251334229. doi: 10.1177/23247096251334229. Epub 2025 Apr 28.
Coccidioidomycosis, endemic in the southwestern United States, can lead to severe pulmonary complications, particularly in chronic obstructive pulmonary disease (COPD) patients with poor lung reserves. has a predisposition for structurally damaged lungs, commonly causing difficult-to-treat bronchiectasis and cavitary lesions. We present the case of a 58-year-old patient with advanced COPD and a remote history of pulmonary coccidioidomycosis diagnosed 30 years earlier, who was found to have sputum and radiographic evidence of cavitary lung disease 4 years prior to admission, but was lost to follow-up. The current presentation is attributed to the progression of untreated infection and reactivation of latent infection. Despite the initiation of antifungal and antibiotic therapy, the subsequent course was complicated by the development of bronchopleural fistula and worsening respiratory failure, leading to an unfavorable outcome. This case highlights the diagnostic challenges associated with overlapping clinical and radiologic features of concurrent infections and devastating outcomes in patients with COPD. Prompt diagnostic testing and prolonged comprehensive therapy are of paramount importance in managing such complex infections.
球孢子菌病在美国西南部为地方性疾病，可导致严重的肺部并发症，尤其是在肺储备功能差的慢性阻塞性肺疾病（COPD）患者中。它易发生于结构受损的肺部，常导致难以治疗的支气管扩张和空洞性病变。我们报告一例58岁的患者，患有晚期COPD，30年前曾诊断为肺球孢子菌病，入院前4年发现有痰液及影像学证据显示有空洞性肺病，但失访。目前的表现归因于未治疗感染的进展和潜伏感染的重新激活。尽管开始了抗真菌和抗生素治疗，但随后的病程因支气管胸膜瘘的发展和呼吸衰竭的恶化而复杂化，导致了不良结局。该病例突出了COPD患者并发感染的临床和放射学特征重叠所带来的诊断挑战以及灾难性后果。及时的诊断检测和长期的综合治疗对于管理此类复杂感染至关重要。
