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Chest Infections |

Rare Initial Presentation of Pulmonary Coccidioidomycosis FREE TO VIEW

Mohamed Fayed, MD; Jose Vempilly, MD
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UCSF Fresno, CA, Fresno, CA


Chest. 2015;148(4_MeetingAbstracts):91A. doi:10.1378/chest.2223585
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Abstract

SESSION TITLE: Chest Infections Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Spontaneous rupture of pulmonary cavity with pyopneumothorax resulting from Coccidioidomycosis has been described in the past. However it is rare as an initial clinical presentation. Early recognition of Coccidioidomycosis related pyopneumothorax as a possibility was based on clinical presentation and laboratory data lead to immediate intervention and successful treatment of Coccidioidomycosis related pulmonary complications.

CASE PRESENTATION: A 53 year old male with no known past medical history presented to emergency department for worsening cough and shortness of breath for 3 days duration. Patient reported chest wall trauma three months ago where a heavy metal fell on his left front chest. He did not seek any medical attention during this time. Although patient noticed intermittent cough, he was fairly asymptomatic till days prior to ER visit. Based on an initial diagnosis of traumatic hydropneumothorax, patient was taken to the OR for VATS then placed on antibiotics for bacterial pyopneumothorax. A clinical diagnosis of pulmonary Coccidioidomycosis related empyema was made by pulmonary consult team based on typical pleural fluid analysis findings. Later the diagnosis was confirmed by histopathology.

DISCUSSION: Rupture of a coccidioidal cavity into the pleural space, resulting in a pyopneumothorax, is an infrequent but serious complication of necrotizing coccidioidal pneumonia. The clinical finding of eosinophils in a lymphocyte rich exudative pleural effusion led to the diagnosis of pyopneumothorax from Coccidioidomycosis. Pleural fluid eosinophilia has not been recognized as a feature of Coccidioidomycosis related pleural effusion. A recent report from our institution showed that Pleural effusion occurs in 15% of hospitalized patients with Coccidiooidomycosis and empyema occurred in approximately 25% of pleural effusions. Presence of even 1% eosinophils in a lymphocyte predominant pleural effusion should alert the clinician to the possibility of Coccidioidomycosis related pleural effusion in endemic areas.

CONCLUSIONS: Pyopneumothorax is a distinct clinical diagnosis of pulmonary coccidioidomycosis. Eosinophils in lymphocyte predominant exudate should alert clinician to Coccidioidomysis related pleural effusion. Recognizing the disease and early treatment is paramount to reduce morbidity and mortality.

Reference #1: Pleural effusion in hospitalized patients with Coccidioidomycosis Respir Med. 2008. PMID: 18164951 2.

Reference #2: Clinical Infectious Diseases 2005; 41:1217-2

Reference #3: J Thorac Cardiovasc Surg. 1982 Aug;84(2):172-7

DISCLOSURE: The following authors have nothing to disclose: Mohamed Fayed, Jose Vempilly

No Product/Research Disclosure Information


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