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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