PURPOSE: To characterize clinical and radilogical aspects of patients with chronic pulmonary coccidioidomycosis.
METHODS: Patients with pulmonary coccidioidomycosis were identified from patient biopsy reports and serology testing during a 2 year period July 2001 through June 2003 at the Southern Arizona (Tucson) VA Medical Center. Ten patients were identified who had chronic pulmonary coccidioidomycosis, but only 6 patients were seen over at least a 2-year period to enable us to characterize the chronicity of their disease.
RESULTS: All 6 patients had disease involving the upper lobes, although one also involved the entire left lung. Some of them were first seen by pulmonary to rule out tubercolsis. Four patients were diabetic, another had glucose intolerance and the last had prostate cancer. All patients had positive IDTP serology that was persistent over the total years of follow-up, ranging from 1:2 to 1:32. All patients required imidazole therapy for treatment of symptoms (chronic fatigue and cough). In two patients imadazole therapy was stopped, but resumed due to resumption of symptoms. Chest X-ray abnormality never resolved.
CONCLUSION: The syndrome of chronic pulmonary coccidioidomycosis is a distinct entity. encountered mostly in diabetic or immunocopromised patients.
CLINICAL IMPLICATIONS: Patients with chronic pulmonary coccidioidomycosis have upper lobe disease which mimics tuberculosis and requires life-long treatment.
DISCLOSURE: Mohamed Zeater, None.