“It’s Not Just Bacteria”: A Cavitary Lung Lesion in a Patient Living in the Coachella Valley
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 fo...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2023-09-01
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| Series: | Journal of Investigative Medicine High Impact Case Reports |
| Online Access: | https://doi.org/10.1177/23247096231197863 |
| _version_ | 1797687215926542336 |
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| author | Harbir Kaur MBBS Jatin Thukral MBBS Anthony Lim MD Julia Oberndorf MD Andrew Sou DO Xolani Mdluli MD |
| author_facet | Harbir Kaur MBBS Jatin Thukral MBBS Anthony Lim MD Julia Oberndorf MD Andrew Sou DO Xolani Mdluli MD |
| author_sort | Harbir Kaur MBBS |
| collection | DOAJ |
| description | 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 Coccidioides 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 Coccidioides posadasii . 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. |
| first_indexed | 2024-03-12T01:15:03Z |
| format | Article |
| id | doaj.art-c3fab1720dcf414b827c47e08654e032 |
| institution | Directory Open Access Journal |
| issn | 2324-7096 |
| language | English |
| last_indexed | 2024-03-12T01:15:03Z |
| publishDate | 2023-09-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Investigative Medicine High Impact Case Reports |
| spelling | doaj.art-c3fab1720dcf414b827c47e08654e0322023-09-13T13:33:32ZengSAGE PublishingJournal of Investigative Medicine High Impact Case Reports2324-70962023-09-011110.1177/23247096231197863“It’s Not Just Bacteria”: A Cavitary Lung Lesion in a Patient Living in the Coachella ValleyHarbir Kaur MBBS0Jatin Thukral MBBS1Anthony Lim MD2Julia Oberndorf MD3Andrew Sou DO4Xolani Mdluli MD5Eisenhower Health, Rancho Mirage, CA, USAEisenhower Health, Rancho Mirage, CA, USAEisenhower Health, Rancho Mirage, CA, USAEisenhower Health, Rancho Mirage, CA, USAEisenhower Health, Rancho Mirage, CA, USAEisenhower Health, Rancho Mirage, CA, USACavitary 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 Coccidioides 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 Coccidioides posadasii . 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.https://doi.org/10.1177/23247096231197863 |
| spellingShingle | Harbir Kaur MBBS Jatin Thukral MBBS Anthony Lim MD Julia Oberndorf MD Andrew Sou DO Xolani Mdluli MD “It’s Not Just Bacteria”: A Cavitary Lung Lesion in a Patient Living in the Coachella Valley Journal of Investigative Medicine High Impact Case Reports |
| title | “It’s Not Just Bacteria”: A Cavitary Lung Lesion in a Patient Living in the Coachella Valley |
| title_full | “It’s Not Just Bacteria”: A Cavitary Lung Lesion in a Patient Living in the Coachella Valley |
| title_fullStr | “It’s Not Just Bacteria”: A Cavitary Lung Lesion in a Patient Living in the Coachella Valley |
| title_full_unstemmed | “It’s Not Just Bacteria”: A Cavitary Lung Lesion in a Patient Living in the Coachella Valley |
| title_short | “It’s Not Just Bacteria”: A Cavitary Lung Lesion in a Patient Living in the Coachella Valley |
| title_sort | it s not just bacteria a cavitary lung lesion in a patient living in the coachella valley |
| url | https://doi.org/10.1177/23247096231197863 |
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