Dataset Information

Serologic Rebound after Stopping Azoles for Primary Pulmonary Coccidioidomycosis: A Case-Controlled Observational Study.

ABSTRACT:

Background

We sought to characterize the outcomes of patients with primary pulmonary coccidioidomycosis whose post-treatment complement fixation (CF) titer increased by more than 2 dilutions (serologic rebound) after discontinuation of antifungal treatment.

Methods

We conducted a retrospective chart review of patients with primary pulmonary coccidioidomycosis and identified immunocompetent, non-pregnant adults who received antifungal treatment and then experienced a serologic rebound after treatment discontinuation. We compared these to matched controls similarly treated who did not have serologic rebound.

Results

Fifty-eight patients experienced serologic rebound. Thirty (52%) of these were associated with symptoms. Nine were associated with radiographic progression. The median time to serologic rebound was 3.5 months. Antifungal treatment was reinitiated in 37 (63.7%) patients. Four of the 58 (6.9%) with rebounded serology subsequently developed extra-thoracic dissemination. Compared with matched controls, patients with rebounded serology were more likely to have post-treatment symptoms, reinitiation of antifungal therapy, and a longer duration of clinical follow-up. However, they were not more likely to experience extra-thoracic dissemination.

Conclusion

Serological rebound, manifested in at least 2-dilution rise of CF titer following antifungal treatment of primary pulmonary coccidioidomycosis, was uncommon, but resulted in longer clinical follow-up. Continued monitoring of such patients is important to identify the patients who develop subsequent symptoms, as well as extra-thoracic dissemination.

SUBMITTER: Shah PJ

PROVIDER: S-EPMC10532748 | biostudies-literature | 2023 Sep

REPOSITORIES: biostudies-literature

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Publications

Serologic Rebound after Stopping Azoles for Primary Pulmonary Coccidioidomycosis: A Case-Controlled Observational Study.

Shah Priyal J PJ Ampel Neil M NM Girardo Marlene E ME Blair Janis E JE

Journal of fungi (Basel, Switzerland) 20230901 9

<h4>Background</h4>We sought to characterize the outcomes of patients with primary pulmonary coccidioidomycosis whose post-treatment complement fixation (CF) titer increased by more than 2 dilutions (serologic rebound) after discontinuation of antifungal treatment.<h4>Methods</h4>We conducted a retrospective chart review of patients with primary pulmonary coccidioidomycosis and identified immunocompetent, non-pregnant adults who received antifungal treatment and then experienced a serologic rebo ...[more]

PMID: 37755009

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Project description:BackgroundPrimary pulmonary artery sarcoma (PAS) is a rare tumor that presents like pulmonary embolism (PE), primary chondrosarcoma in the pulmonary artery is even rarer and few studies have been reported. PAS are commonly misinterpreted as in a clinical setting, many patients initially receive anticoagulant and thrombolysis therapy, but failed to respond. Management of this condition is difficult and prognosis is poor. We report a case of primary pulmonary artery chondrosarcoma that was initially misdiagnosed as PE and Inappropriate interventional therapy was performed, but with poor response. Finally, patient received surgical treatment, postoperative pathology confirmed primary pulmonary artery chondrosarcoma.Case descriptionA 67-year-old woman who had presented with cough, chest pain and shortness of breath for more than 3 months. Computed tomography pulmonary angiography (CTPA) showed filling defects were seen in the right and left pulmonary arteries, spreading to the outer lumen. The patient was initially diagnosed with PE and underwent transcatheter aspiration for pulmonary artery thrombus, transcatheter thrombolysis, and inferior vena cava filter placement at a local hospital, but with poor response. She was then referred for pulmonary artery tumor resection, endarterectomy and pulmonary arterioplasty. Histopathological examinations confirmed a diagnosis of primary PAS (chondrosarcoma). The patient developed in situ recurrence of pulmonary artery tumors in 10 months after surgery and received six cycles of adjuvant chemotherapy. The lesions progressed slowly after chemotherapy. The patient subsequently developed lung metastasis in 22 months and died of heart failure and respiratory failure 2 years after surgery.ConclusionsPAS is an extremely rare and the clinical symptoms and radiological features often mimics PE, therefore When doctors make differential diagnosis of pulmonary artery mass lesions, especially when the anticoagulation and thrombolytic effects are very poor. They need to be alert to the possibility of PAS so that early diagnosis and early treatment can prolong the survival of patients.

Dataset Information

Serologic Rebound after Stopping Azoles for Primary Pulmonary Coccidioidomycosis: A Case-Controlled Observational Study.

Background

Methods

Results

Conclusion

Publications

Serologic Rebound after Stopping Azoles for Primary Pulmonary Coccidioidomycosis: A Case-Controlled Observational Study.

Similar Datasets

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