A 76-year-old man had onset of rash and night sweats in September 1992. The patient was found to have a right pleural effusion. Serology was positive for coccidioidomycosis and a pleural fluid sample was negative for fungus culture. No specific therapy was given. In September 1993, a large mediastinal mass was noted. At that time the patient had complaints of occasional dysphagia. A barium swallow revealed evidence of deviation and extrinsic compression of the esophagus. Biopsy tissue obtained at mediastinoscopy revealed granulomas and spherules. He was treated with amphotericin to a total dosage of 1,350 mg, then changed to fluconazole at 200 mg twice daily. A followup CT scan in February 1994 revealed a slight increase in the size of the mass and its extension to the chest wall. In the interim, the patient's dysphagia worsened. Therapy was changed in April 1994 to itraconazole, 200 mg twice a day. This is the first case of compression of the esophagus by Coccidioides of which we are aware.
Full conference title:
Coccidioidomycosis - Centennial Conference