Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a subacute onset of cough, pleuritic chest pain, and low-grade fevers. Reports recent travel or residence in endemic regions (e.g., Southwestern US). Associated symptoms include fatigue, night sweats, arthralgias (desert rheumatism), and occasional erythema nodosum or multiforme. Denies hemoptysis or significant weight loss.
Clinical Examination Findings
General: Patient appears mildly ill, febrile. HEENT: No cervical lymphadenopathy. Respiratory: Auscultation reveals localized or diffuse crackles, diminished breath sounds if effusion present. Skin: Inspection reveals erythematous, tender nodules on lower extremities (erythema nodosum) or maculopapular rash. Musculoskeletal: Tenderness noted in large joints.
Treatment Protocol
Initiate antifungal therapy (Fluconazole or Itraconazole) for symptomatic or disseminated disease. Monitor LFTs and renal function. For severe or pulmonary cavitary disease, consider Amphotericin B. Supportive care includes NSAIDs for arthralgias and pleuritic pain. Follow-up serology (CF/ID) and chest imaging as indicated.