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?
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2. Do you have familiarity with the subject matter described above?
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3. Have you ever published or lectured on this subject / issue?
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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.
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