PT  - JOURNAL ARTICLE
AU  - Nandu Nair
AU  - Nandakishore Baikunje
AU  - Giridhar Belur Hosmane
AU  - Sunil Kumar
TI  - Coccidioidomycosis where you least expect it
AID  - 10.1136/bcr-2021-248711
DP  - 2022 Sep 01
TA  - BMJ Case Reports
PG  - e248711
VI  - 15
IP  - 9
4099  - http://casereports.bmj.com/content/15/9/e248711.short
4100  - http://casereports.bmj.com/content/15/9/e248711.full
SO  - BMJ Case Reports2022 Sep 01; 15
AB  - An elderly man without history of travel presented with complaints of intermittent fever for 2 months, cough with scanty expectoration for 15 days and history of weight loss of 5 kg in 1 year. The chest X-ray and CT scan of the thorax showed dispersed centrilobular nodules and patchy subpleural consolidation in both lungs with mediastinal lymphadenopathy. He underwent bronchoscopy and bronchoalveolar lavage culture grew Pseudomonas aeruginosa. He was prescribed antibiotics based on culture sensitivity; however, patient continued to have symptoms. All relevant blood investigations were within normal limits. He underwent CT-guided biopsy of the right lung lesion during which clearing of the radio-opacities present in the initial CT scan and appearance of fresh lesions in different locations were observed. Migratory shadows were suspected. Fine-needle aspiration cytology showed features suggestive of coccidioidomycosis for which antifungals were started. After 1 month, he improved symptomatically and chest X-ray showed clearance of shadows.