Fluconazole in the Treatment of Persistent Coccidioidomycosis: RESULTS part 2
Of the 12 who initially responded, only four remained free of coccidioidal disease. These patients have been followed for 10, 13, 15, and 18 months. One patient died of a myocardial infarction at the end of successful treatment of his fungal infection. Six of the 11 surviving responders had a relapse nine days to 15 months after treatment was stopped. Only one responder suffered a relapse while still receiving fluconazole. The clinical courses of the patients who had a relapse are summarized briefly.
Patient 3 had longstanding fibrocavitary disease. He previously had responded to amphotericin B, but suffered a relapse. A similar scenario followed treatment with ketoconazole. He then responded well to treatment with fluconazole (50 mg/day), with resolution of all pulmonary symptoms but minimal improvement in his roentgenogram. Eight months after fluconazole had been discontinued, the patient developed fever, weight loss, and a productive cough, and С immitis was again recovered from his sputum.
4 had longstanding fibrocavitary pulmonary disease and was treated for 12 months at a dose of 50 mg/day. She became free of symptoms, and cultures of sputum were repeatedly negative. Nine days after treatment was stopped, she suffered recurrence of cough, sputum, and hemoptysis. A sputum culture was positive for С immitis.
Patient 5 presented with fever, weight loss, a cutaneous lesion, cervical adenopathy, pulmonary symptoms, and an infiltrate with hilar adenopathy on chest roentgenograms. He responded well to a course of treatment of 50 mg/day for 4.5 months. Two months after fluconazole was discontinued, he developed coccidioidal meningitis.
Patient 7 had cervical and azygous adenopathy, as well as epididymitis. He responded to treatment with resolution of his lesions. Four months after discontinuation of fluconazole, a new cervical lymph node enlarged. It was biopsied, and the culture grew С immitis.
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Patient 10 had a longstanding soft tissue infection adjacent to the greater trochanter. The lesions were drained surgically, and the patient was treated with fluconazole at 50 mg/day for 12 months. All symptoms cleared, and radiographic abnormalities improved. Six weeks after discontinuation of fluconazole, local pain recurred. Needle aspiration yielded С immitis.
Patient 11 initially responded, but after 22 months of treatment, a deep abscess wound reopened. Staphylococcus aureus and С immitis were recovered from the wound.
Patient 12 had peritonitis and several cutaneous lesions. Treatment resulted in resolution of the cutaneous lesions. Eight months after the drug was stopped, one cutaneous lesion recurred, and С immitis was found on biopsy. Peritonitis did not recur.