Coccidioidomycosis as a rare cause of pneumonia in non-endemic areas: a short exposure history should not be ignored.
Coccidioidomycosis is endemic in the south-western USA. Two cases of infection in travellers returning to Hong Kong are described. A previously healthy patient who had travelled to an endemic area for a short time was successfully treated with fluconazole. A second patient with comorbidities and more prolonged exposure had disseminated and eventually fatal disease, despite prolonged administration of anti-fungal agents. Although coccidioidomycosis is a rare disease in Hong Kong, it should always be considered when there is a relevant travel history. Even a short period of travel to an endemic area should alert clinicians to this possibility when managing patients with severe pneumonia, especially those with multi-organ involvement. On the other hand, in patients with comorbidities, even aggressive and prolonged anti-fungal therapy may not guarantee a successful outcome.
Kwok
Henry K H
HK
Hospital Authority Head Office, Queen Elizabeth Hospital, University of Hong Kong, Hong Kong, China. kwokkhh@ha.org.hk
Chan
Johnny W M
JW
Li
Iris W S
IW
Chu
Stephanie Y Y
SY
Lam
Chak Wah
CW
D000328:Adult; D003045:Coccidioides; D003047:Coccidioidomycosis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000382:microbiology* / Q000628:therapy; D014195:Travel; D014481:United States