Between 1991 and 1994, we at King/Drew Medical Center saw 14 patients with Coccidioidomycosis of the lymphatic system. One patient had bilateral chylous empyema secondary to thoracic duet compression by mediastinal lymphadenopathy mistaken for lymphosarcoma. Several other patients also presented with massive lymph nodes in the superior mediastinum extending into the root of the neck. All of them showed intense uptake of Gallium(67) in the lymph nodes, Six patients were in California prisons located in areas highly endemic to ''cocci.'' Two patients who had lymph node resection or biopsy had persistent sinus tract problems for more than a year. Four patients died despite multiple courses of amphotericin B and fluconazole, One of the patients who had abnormal T4 cells tested negative for HIV-1 and HIV-2, but had symptoms of AIDS. Patients acquired their infection during the dust storms of 1992, 1993, and the recent earthquake. Those who were in prisons at that time filed compensation claims against the State of California. Of five who are alive, none appeared to have been completely cured. Clinicians should be aware of the lymphosarcoma type of presentation and refrain from doing lymph node biopsies in suspected cases of coccidioidomycosis.
Full conference title:
Coccidioidomycosis - Centennial Conference