• 10
    May
  • Fluconazole in the Treatment of Persistent Coccidioidomycosis: RESULTS part 2

Fluconazole in the Treatment of Persistent Coccidioidomycosis: RESULTS part 2

Subsequent Course

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.

 

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