Post on 29-Jun-2015
description
transcript
Cytopathology Conference
10/20/2005
Case 5
FNA from a 1.5 cm left lung mass in a 61-year-old male.
Differential Diagnosis
• Histoplasmosis
• Coccidiodes
• Blastomycosis
• Cryptococcus
Diagnosis?
Coccidioides immitis
Coccidioides immitis
• Dimorphic fungus: filamentous, mycelia form and spherule form in tissues
• Coccidomycosis, a.k.a. Valley Fever or San Joaquin Valley fever
• Inhalation of arthrospores from the soil
• Endemic in Southwest
Coccidioides immitis
• 60% of primary infections are asymptomatic
• Remaining 40% usually recover form a flu-like illness (cough, fever, pleuritic chest pain)
• Dissemination more likely in Filipino, African American, Mexican and American Indian races.
Coccidioides immitis
• Diagnosis:
– Chest x-ray: hilar adenopathy, cavitations
– IgM precipitins present after 4 weeks of symptoms; complement fixing IgG antibodies appear later.
– Complement fixations titer > 1:16 or 1:32 is consistent with extrapulmonary dissemination
• Rx: – Amphotericin B, Ketaconazole