A 42-year-old woman from Arizona presents with a 3-month history of progressive cough, hemoptysis, and night sweats. She denies dyspnea at rest but reports fatigue. Vital signs: BP 128/82 mmHg, HR 96/min, RR 20/min, Temperature 37.8°C, SpO2 94% on room air. Chest X-ray shows a left upper lobe cavitary infiltrate with surrounding consolidation. Sputum acid-fast bacilli smears are negative on three separate occasions. Serum testing demonstrates elevated coccidioidal IgM and IgG antibodies. Sputum culture grows Coccidioides immitis. The patient has no immunocompromise and normal renal function. Which of the following is the most appropriate treatment?
- A)Amphotericin B lipid complex intravenously
- B)Itraconazole orally for 6-12 monthsGABARITO
- C)Isoniazid, rifampin, pyrazinamide, and ethambutol
- D)Terbinafine orally
- E)Supportive care alone with serial imaging follow-up
Explicação
Coccidioidomycosis with pulmonary cavitary disease in an immunocompetent host is treated with azole antifungals, specifically itraconazole or fluconazole orally for prolonged periods (6-12 months). Itraconazole achieves excellent lung penetration and is prefer... Ver explicação completa e trilha adaptativa →