Pulmonary Coccidioidomycosis: One Case Report And Literature Review

Objective:To improve the identification of pulmonary coccidioidomycosis by reporting one case and analyzing the clinical characteristics, laboratory examination, radiological, pathological features, treatment and prognosis of characteristics.Methods:Report 1 case of pulmonary coccidioidomycosis confirmed by the ultrasound-guided percutanenous lung biopsy in respiratory medicine of the Second Hospital Affiliated to Zhejiang University. Fifteen pulmonary coccidioidomycosis cases reported in mainland China from 2000 to 2016 were retroactively analyzed and literature reviewed.Results:We analyzed 15 cases diagnosed with pulmonary coccidioidomycosis confirmed by lung biopsies. There were 11 males and 4 females, with a mean age of 50.89 years(range 14-81 years). Clinical features were nonspecific. Majority of the patients were presented cough, sputum, fever and chest pain, minority of them were presented hemoptysis, shortness of breath, dizziness, headache and other symptoms. Laboratory examination were nonspecific, minority of the patients were presented White blood cell count (WBC)and Elevation of erythrocyte sedimentation rate (ESR) high. Radiographic features were also nonspecific. Majority of the patients were presented nodules or high density patchy shadow, difficult to distinguish from the lung cancer, pulmonary tuberculosis and the other lung fungal infections. The method of diagnosis including ultrasound/CT-guided percutanenous lung biopsy, surgical lung biopsy and transbronchial lung biopsy, the Coccidioides spherule containing endospores could be found in all the pathological tissue. Surgical treatment and antifungal therapy resulted in rapid clinical improvement in pulmonary coccidioidomycosis cases.Conclusion:Pulmonary coccidioidomycosis results in good prognosis if it is administrated in time, because of the rare cases reported and no specificity in the clinical features, laboratory examination, radiographic features, the patients in our country were often misdiagnosed. To make sure of patient’s medical history, effective pathological tissue diagnosis and use antifungal therapy is the best way.