INTRAPLEURAL AMPHOTERICIN B INSTILLATION: A NOVEL APPROACH TO THE TREATMENT OF CHRONIC PULMONARY COCCIDIOIDOMYCOSIS

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Coccidioidomycosis is transmitted by inhalation of fungal spores commonly found in southwestern border United States and South America. Most primary coccidioidomycosis cases are asymptomatic do not require treatment. Symptomatic progressive affect people with certain risk factors: ethnic origin, advanced age, pregnancy, immunosuppressive state. effectively treated oral triazoles. Intravenous (IV) amphotericin B (AMB) reserved for severe cases. Although intrapleural instillation AMB has been reported aspergillus empyema, it other diseases (1). We reporting the first known case successful novel use treatment chronic pulmonary coccidioidomycosis. CASE PRESENTATION: A 48-year-old Hawaiian man diabetes mellitus type 2 presented 10 days epigastric pain, anorexia, constipation, chills, shortness breath, low-grade fever. He had a 9-month nonproductive cough after returning from Las Vegas. was admitted to another facility where he diagnosed cryptogenic organizing pneumonia moderate dose prednisone over 6 months. Initial chest x-ray here revealed large left pneumothorax. tube insertion did provide significant improvement. Subsequent computerized tomography (CT) hydropneumothorax lingular lung base consolidation. Transbronchial biopsy showed coccidioides. After 7 hospitalization, patient discharged home fluconazole. readmitted weeks later due recurrence same set symptoms. CT scan now progression multifocal necrotizing pneumonia. Based on continued deterioration despite IV AMB, there high suspicion persisting infection pneumonectomy placement special drainage catheter performed, addition AMB. tolerated well 9 afterward One year able resume all normal activities. DISCUSSION: Our developed uncontrolled prolonged use. pneumonia, nodules cavities, fever, cough, hemoptysis, abdominal weight loss, weakness. Due many adverse reactions generally cases; our case, conjunction his antifungal therapy. CONCLUSIONS: This instillation, combination conventional therapy, REFERENCE #1: Almuhareb, A., & Habib, Z. (2018). Management Aspergillus Pleural Empyema Combined Systemic Intrapleural Antifungal Therapy Pediatric Patient: Report. Journal Infection Public Health, 11(2), 280-282. DISCLOSURES: No relevant relationships Angelica Guzman Paz, source=Web Response Takkin Lo,