Infection of an arterial prosthesis as the presenting manifestation of disseminated coccidioidomycosis: control of disease with fluconazole.
We describe an elderly man whose presenting manifestation of disseminated coccidioidomycosis was bilateral infection of femoral arterial prosthetic grafts. After the patient failed to respond to both ketoconazole and amphotericin B, treatment with fluconazole brought about clinical resolution of meningitis and pulmonary disease and, in combination with repeated percutaneous aspiration, control of the arterial infection. The unusual clinical features of this case, along with the incidence and management of prosthetic arterial infections caused by fungi, are discussed.
Infectious Disease Section, Seattle Veterans Affairs Medical Center, Washington 98108.
D N
DN
Schwartz
S D
SD
Fihn
R A
RA
Miller
D000368:Aged; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D003047:Coccidioidomycosis / Q000150:complications / Q000188:drug therapy*; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000382:microbiology; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D008171:Lung Diseases / Q000382:microbiology; D008297:Male; D008581:Meningitis / Q000382:microbiology; D016491:Peripheral Vascular Diseases / Q000382:microbiology; D014057:Tomography, X-Ray Computed
D015725:Fluconazole