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Pain Management 2018
Internal Medicine 2018
International Journal of Anesthesiology & Pain Medicine
ISSN: 2471-982X
Page 45
March 26-28, 2018
Vienna, Austria
JOINT EVENT
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E d i t i o n o f I n t e r n a t i o n a l C o n f e r e n c e o n
Internal Medicine and Patient Care
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E d i t i o n o f I n t e r n a t i o n a l C o n f e r e n c e o n
Pain Management
Volume 4
Background:
Coccidioidomycosis is caused by Coccidioides
immitis and by C posadasii, approximately 60-65% of cases are
asymptomatic, however, it may present with fever, sore throat,
cough, headache, fatigue, and pleuritic chest pain. Here we
present a case of back pain who was found to have an aneurysm,
hewas later found to have coccidioidomycosis. The only other risk
factor that could have possibly contributed to this presentation
was hypertension.
Case:
This is a 59-year-old male who presented with acute
worsening chronic back pain which apparently started after
he twisted his back while playing golf. On admission his blood
pressure was elevated at 175/99 mm Hg, he was afebrile with a
temp of 97.7°F, pulse was 59/min, respiratory rate was 16/min
and SpO2 was 99% on room air. Physical exam was remarkable
for Paraspinal tenderness at L4-L5 level. Labs were significant for
initial troponin of 0.09. Initial EKG showed T wave inversion in the
inferior leads. So the decision was made to start heparin, aspirin
and carvedilol. Cardiology performed cardiac catheterization
which showed mild, nonobstructive CAD with EF of 60% as well
as an ascending aortic aneurysm without dissection. So we
ordered computed tomography (CT) angiogram which showed
ascending aorta pulmonary artery measuring 5.3 x 5.2 cm. There
was no previous CT chest for comparison. Cardiothoracic surgery
recommended outpatient follow up with CT in three months. Two
days after the discharge of the coccidioidomycosis antibody
test was positive with titer reactive at 1:2. A prescription for
four weeks of fluconazole was then provided in the view of the
diagnostic results.
Discussion:
The various etiological factors of ascending aortic
aneurysms include Marfan syndrome, type IV Ehlers-Danlos
syndrome, atherosclerosis, bacterial [mycotic or syphilitic],
arteritis (i.e., giant cell, Takayasu, Kawasaki, Behçet), and
trauma. Coccidioidomycosis has never been reported to have
caused thoracic aneurysm making this a rare case. Even though
underlying hypertension increases the risk of an aneurysm, the
presence of coccidioidomycosis at the time of its discovery
makes it a possible etiological factor in this patient.
Biography
Maitreyee Rai Michigan State University, USA.
mrdr18@outlook.comCoccidioidomycosis causing ascending aortic aneurysm?
Maitreyee Rai, Manoj Rai, Mark Mujier, Atinuke Aluko and Shilpa Kavuturu
USA
Maitreyee Rai et al., Int J Anesth Pain Med 2018, Volume 4
DOI: 10.21767/2471-982X-C1-002