0
Chest Infections: Fellow Case Report Poster - Chest Infections II |

All That Is Miliary Is Not TB: A Case of Disseminated Pulmonary Coccidioidomycosis

Madhu Kalyan Pendurthi, MBBS; Pralay Sarkar, MD; Kalpalatha Guntupalli, MD
Author and Funding Information

Baylor College of Medicine, Houston, TX


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(4_S):127A. doi:10.1016/j.chest.2016.08.136
Text Size: A A A
Published online

Extract

SESSION TITLE: Fellow Case Report Poster - Chest Infections II

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Miliary nodular pattern on lung imaging is commonly associated with miliary tuberculosis. Disseminated pulmonary coccidioidomycosis is a close mimicker.

CASE PRESENTATION: 30 year old construction worker presented with 3 weeks of dry cough and low grade fever. He coughed a small amount of blood 2 days prior to the clinic visit. Clinical exam was unremarkable. 1 month ago he returned from a trip to Queretaro, Mexico. Patient was a life time non-smoker, no history of illicit drug use, inhalational exposure and sick contacts. Patient was admitted to air borne isolation, 3 serial sputum specimens were negative for acid fast bacilli. CT scan of chest showed diffuse pulmonary nodules in random distribution.HIV was negative. Considering the recent trip to a highly endemic area of tuberculosis patient was started on a four drug regimen anti-tubercular therapy. Flexible fibre-optic bronchoscopy showed multiple fleshy pale yellow nodules in the right tracheobronchial tree. Endobronchial biopsies were obtained from involved areas and trans-bronchial biopsies from the right lower lobe. Bronchial alveolar lavage was lymphocyte and eosinophil predominant. Bacterial, fungal and mycobacterial cultures were negative. Histopathology of bronchial biopsies showed abundant chronic inflammatory cells and scattered coccidioidomycosis spherules with endospores. Serum coccidioidomycosis antibodies were elevated at 1:8. Anti-tubercular therapy was stopped and patient was treated with flucanozole.

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543