This is a report on six California residents who developed severe and persistent cough between 1991 and 1993. All were bronchoscoped; endobronchial nodules were noted and were associated with edematous bronchitis. The nodules were sessile (3 to 10 mm) with yellow centers. Biopsies revealed granulomatous inflammation with spherules. The nodules and bronchitis were situated proximal to radiographic infiltrates and enlarged lymph nodes, Three patients had narrowing of the bronchial lumen due to bronchitis or extrinsic compression. One had a markedly compressed left main stem bronchus and required a stent. Serial observations revealed resolution of the nodules, formation of nodules from bronchitis, and persistence of the nodules with or without decrease in size. Five of the six patients received consecutive amphotericin B-fluconazole therapy and were followed longer than 1 year. The cough subsided over 2 to 4 months of treatment. Two patients had serological relapse (CF = 1:32,4 +) within 3 months of discontinuing fluconazole. The disease resolved completely in the two patients who had early conversion of skin tests and never developed CF titers. Chronic disease has persisted in the four others who failed to convert or had late skin test conversion and CF antibodies. Coccidioidal pneumonia with nodular bronchitis is an intense infection which usually presents subacutely, persists, and requires aggressive and lengthy treatment.
Full conference title:
Coccidioidomycosis - Centennial Conference