Category Archives: #Pulmonology

8/9 Morning Report w/ Aaron Lam: Work up for coccioides

A middle aged man w/ well-controlled HIV and seasonal allergies p/w recurrent episodic flu-like illness during travel to arizona + persistent cough. His work-up is still ongoing, but he’s undergone allergy testing and has seen pulmonology as an outpatient.

This patient tested negative for cocci, but a few interesting teaching points about cocci came up during our discussion:

1) The cocci antibody should be used as a screening test – it is sensitive but not specific. The immunodiffusion and complement fixation tests are specific, and can be used to monitor response to therapy

2) Healthy young people with primary cocci (PNA) not requiring hospitalization generally do NOT need to be treated! Treat if >10% weight loss, persistent night sweats x 3 weeks, complement fixation titers > 1:16, out of work, HIV, or sx > 2 months

*Individuals of African or Philippine descent have an increased risk of extra-pulmonary complications


7/13 Morning Report w/ Moyukh and Dr. Addison: Radiation Pneumonitis

A women w/ recently treated breast cancer presents with dry cough and worsening lung infiltrates despite antibiotics, ultimately diagnosed with radiation pneumonitis.
*Take home points: Recognize radiation pneumonitis as a cause of dry cough + infiltrates appearing 1-12 months after thoracic or neck radiation. Infiltrates are usually ipsilateral but can be contralateral to radiation. Diagnose by excluding other causes including infection, malignancy, thromboembolic disease, drug-induced (these patients are at risk for all). Once confirmed, can monitor CXRs q4-6 weeks to make sure it resolves spontaneously or treat if symptomatic (steroids).*