Case Report

Unusual Case of Pyopneumothorax in Tennessee

Authors: Souad S. Youssef, MD, Vijay Ramu, MD, Felix A. Sarubbi, MD


Rupture of a coccidioidal pulmonary cavity with subsequent pyopneumothorax is a rare clinical event, even in areas endemic for coccidioidomycosis. Our encounter with a patient diagnosed with this condition in northeast Tennessee serves notice to clinicians that coccidioidomycosis is indeed a traveling fungal disease, and practitioners must be alert to common and uncommon manifestations of infection associated with this fungus. A literature review pertaining to coccidioidal pyopneumothorax revealed that patients usually present with a recent onset of chest pain. Serologic testing and pleural fluid culture are highly useful, and management includes surgical intervention with or without antifungal therapy.

Key Points

* Infection due to Coccidioides can be encountered outside the usual endemic areas and clinicians must be aware of the clinical spectrum.

* Rupture of a coccidioidal pulmonary cavity is a rare event and can result in pyopneumothorax.

* Treatment of pyopneumothorax due to Coccidioides requires surgical intervention with or without antifungal therapy.

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1. Bayer AS, Yoshikawa TT, Galpin JE, et al. Unusual syndromes of coccidioidomycosis: diagnostic and therapeutic considerations. Medicine 1976;55:131–152.
2. Edelstein G, Levitt RG. Cavitary coccidioidomycosis presenting as spontaneous pneumothorax. Am J Roentgenol 1983;141:533–534.
3. Snyder LS, Galgiani JN. Coccidioidomycosis: the initial pulmonary infection and beyond. Semin Respir Crit Care Med 1997;18:235–247.
4. Desai SA, Minai OA, Gordon SM, et al. Coccidioidomycosis in non-endemic areas: a case series.Respir Med 2001;95:305–309.
5. Crum NF, Lederman ER, Stafford CM, et al. Coccidioidomycosis: a descriptive survey of a reemerging disease: clinical characteristics and current controversies. Medicine 2004;83:149–175.
6. Smith CE, Beard RR, Saito MT. Pathogenesis of coccidioidomycosis with special reference to pulmonary cavitation. Ann Intern Med 1948;29:623–655.
7. Smith CE, Beard RR, Whiting EG, et al. Varieties of coccidioidal infection in relation to the epidemiology and control of the disease. Am J Public Health 1946;36:1394–1402.
8. Batra P. Pulmonary coccidioidomycosis. J Thorac Imaging 1992;7:29–38.
9. Scully RE, Mark EJ, McNeely WF, et al. Case records of the Massachusetts General Hospital: case 21–1994. N Engl J Med 1994;330:1516–1522.
10. Cunningham RT, Einstein H. Coccidioidal pulmonary cavities with rupture. J Thorac Cardiovasc Surg1982;84:172–177.
11. Haber K, Freundlich IM. Spontaneous pneumothorax with unusual manifestations. Chest1974;65:675–676.
12. Dolan MJ, Lattuada CP, Melcher GP, et al. Coccidioides immitis presenting as a mycelial pathogen with empyema and hydropneumothorax. J Med Veterinary Mycol 1992;30:249–255.
13. Hyde L, Holman DC. Coccidioidal spontaneous hydropneumothorax. Ann Intern Med 1957;47:1234–1242.