Coccidioidal pulmonary cavities with rupture

Area of Science:

• Pulmonary Medicine
• Infectious Diseases
• Thoracic Surgery

Background:

• Coccidioidomycosis can lead to spontaneous rupture of pulmonary cavities.
• This rupture can result in a pyopneumothorax, a serious medical emergency.
• Diagnosis and management of this condition present significant clinical challenges.

Purpose of the Study:

• To present findings on 23 patients with pyopneumothorax from ruptured coccidioidomycosis cavities.
• To detail clinical, laboratory, and treatment outcomes, including surgical interventions.
• To provide recommendations for timely diagnosis and management.

Main Methods:

• Retrospective review of 23 patients with spontaneous rupture of pulmonary cavities due to coccidioidomycosis.
• Analysis of clinical presentations, laboratory results (skin tests, complement fixation titers, cultures), and treatment strategies.
• Detailed reporting of surgical procedures (lobectomies, partial lobectomies, pneumonectomy, decortication) and medical management (Amphotericin B).

Main Results:

• Surgical treatment was performed in 21 patients, with various resection types and decortication in 17.
• No deaths occurred among the 23 patients; three major complications were reported.
• Laboratory tests like skin tests were not diagnostic; elevated titers and positive cultures did not warrant delaying surgery.
• Amphotericin B was administered to 10 patients, particularly in acute phases, diabetic patients, or with limited resections.

Conclusions:

• Prompt surgical intervention is recommended for suspected pyopneumothorax from coccidioidomycosis.
• Factors like delayed treatment, diabetes, and comorbidities may necessitate postponing surgery.
• The extent of resection might be limited by pleural space contamination; Amphotericin B is a valuable adjunct in specific clinical scenarios.