title: [Case of cavitary coccidioidomycosis with fungus balls in the apices of both lungs].
abstract: Pulmonary cavitary coccidioidomycosis with a fungus ball was observed in a immunocompetent case. A 32-year-old Japanese man visited Arizona to play golf. After 1 month he consulted a local hospital complaining of a prolonged cough and hematopysis. The laboratory examination revealed eosinophillia and chest radiograph showed 2 cavitary lesions, surrounded by small nodules in the apices of both lungs. Pulmonary tuberculosis was suspected and treated with 4 antituberculosis drugs for 3 months. However, the cavities enlarged and he was admitted to our hospital for further examination and treatment. Transbronchial lung biopsy was performed and serologically, bacteriologically and histologically a diagnosis of chronic coccidioidmycosis was made. It is very rare for fungus ball formation and coexistence of spherules and hyphae of Coccidioides immitis to be seen. Fluconazole was temporarily effective, causing cavities to shrink and eosinophilia to decrease, however Amphotericin B needed to be used later. Eosinophilia was closely related to the severity of the disease gravity.
authors.affiliation: Department of Respiratory Medicine, International Medical Center of Japan.
authors.forename: Eriko
authors.initials: E
authors.lastname: Morino
authors.forename: Gou
authors.initials: G
authors.lastname: Naka
authors.forename: Shinyu
authors.initials: S
authors.lastname: Izumi
authors.forename: Atsuto
authors.initials: A
authors.lastname: Yoshizawa
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kawana
authors.forename: Emiko
authors.initials: E
authors.lastname: Toyota
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kudo
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D015415:Biomarkers; D002908:Chronic Disease; D003045:Coccidioides / Q000302:isolation & purification; D003047:Coccidioidomycosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D018450:Disease Progression; D004802:Eosinophilia; D006801:Humans; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D008297:Male; D012698:Serologic Tests; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D015415:Biomarkers; D000666:Amphotericin B