Infectious Disease Experts Discuss Misdiagnosed Lung Infection

This case involves a middle-aged male patient who underwent a routine chest x-ray that revealed an area of density in his lung. Subsequently, a cat scan was performed, which revealed a concerning lesion that doctors recommended be tested for malignancy. The patient was advised to undergo a biopsy, which did not detect malignancy, however the sample did contain a number of white blood cells. The patient shared that he had recently moved from an area of the country in which a certain kind of lung infection is known to exist, however this was not taken into consideration. Eventually, after some additional testing, the patient underwent a lobectomy as well as the removal of several lymph nodes. It was at this point that the mass was revealed to be an infection rather than a cancerous mass.

Question(s) For Expert Witness

1. Do you routinely treat patients like the one described above?

2. Do you have familiarity with the subject matter described above?

3. Have you ever published or lectured on this subject / issue?

4. Is it possible that if a lung nodule containing this infection is present in a patient, the symptoms will usually fully resolve after a course of the appropriate medication?

Expert Witness Response E-037922

I routinely treat patients like the one described. I have published and lecture on the matter, Treatment likely would not have changed the size or presence of the nodule within days or even a couple of weeks - when we re-scan these patients, we often find the nodule lingers for several months into therapy, often even longer. Although it's often unfortunately a biopsy-based diagnosis, there are some tests available (a urine coccidioides antigen), serum beta-glucans, but the sensitivity/specificity of these tests for cocci are not high. My field of clinical and research expertise is invasive fungal disease.