A Caucasian male in his mid-50s presented to a community hospital in fall 2020 with
a 1-month history of nonproductive cough, nausea, vomiting, chills, and nightly fevers
greater than 40°C with associated diaphoresis. His past medical history included limited-cutaneous
systemic sclerosis (Lc-SSc) diagnosed 5 years prior, SSc-related interstitial lung
disease (SSc-ILD), dyslipidemia, osteoporosis, nephrolithiasis, and gastroesophageal
reflux. His interstitial lung disease was diagnosed 2 years prior to presentation,
and he was responding well to mycophenolate mofetil and oral low-dose prednisone daily.
Most recent pulmonary function test showed a forced expiratory volume in 1 second
to forced vital capacity ratio of 85%, forced expiratory volume in 1 second of 2.43
L or 74% predicted, total lung capacity 3.89 L or 60% predicted, and a diffusion capacity
of 27% predicted. There was no history of recent travel, and the patient was a lifetime
nonsmoker with no alcohol use. He was working as a cemetery caretaker with direct
soil exposure, but there was no history of similar illness among his coworkers. He
was prescribed azithromycin and moxifloxacin in the community for a presumed pneumonia.
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References
- Larone's medically important fungi: a guide to identification.6th ed. ASM Press, Washington, DC2018
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Article info
Publication history
Published online: December 07, 2022
Thomas J. Marrie, MD, Section EditorPublication stage
In Press Journal Pre-ProofFootnotes
Funding: None.
Conflicts of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
Copyright
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