Primary pulmonary coccidioidomycosis: a case report and review of the literature

Abstract

Objective To further improve the understanding of the clinical characteristics, diagnosis, and treatment of pulmonary coccidioidomycosis. Methods This article summarized the clinical data of one case of pulmonary coccidioidomycosis, reviewd the literatures, and analyzed the clinical manifestations, pathological results and treatment of pulmonary coccidioidomycosis. Results A 22 years old female student was admitted to the hospital with three weeks of fever and productive cough.Chest CT from external hospital showed bilateral lung infections, bilateral pleural effusion; multiple enlarged lymph nodes in mediastinum and right lung hilum as well as pericardial effusion.Bacterial pneumonia was diagnosed and the patient was treated with standard anti-infective therapy for two weeks, but there was no improvement.In the First Affiliated Hospital of Nanjing Medical University, percutaneous lung puncture biopsy was performed under CT, and the postoperative pathological results showed (right lower lung puncture) cord-lung tissue, granulomatous inflammation in focal areas, suspicious sporlike substance in multicellular giant cells, the diameter of the largest one was 20 μm, suggestting coccidioides infection.The patient administered oral fluconazole 400 mg/d, and chest CT examination after three months showed significantly reduced lesions. Conclusions Primary pulmonary coccidioidomycosis is a rare disease in clinic.Clinical manifestations and imaging characteristics of pulmonary coccidioidomycosis are nonspecific.The final diagnosis depends on pathology.The patients of pulmonary coccidioidomycosis gradually increase in non-epidemic areas with the increase in international communication.Clinicians should improve the understanding of the diagnosis and treatment of the disease. Key words: Pulmonary coccidioidomycosis; Fungi; Diagnosis; Treatment