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2. Fluconazole
Candidiasis can be seen in immunocompromised hosts such as this lady receiving immunosuppressants for her rheumatologic disease or in AIDS (1). Fluconazole is generally considered the drug of choice in nonneutropenic patients. Although nystatin might be helpful it is unlikely that this would be sufficient to control the Candidiasis in this immunocompromised woman. Intravenous liposomal preparations of amphotericin B are often used for invasive candidiasis. Should her disease progress while on fluconazole this would be considered an alternative.
She is begun on fluconazole and clinically improves. However, three months later she presents with generalized malaise and poor oral intake. She denied shortness of breath, cough, or chest pain. Her SpO2 was 80% on room air. A chest x-ray was performed (Figure 2)
Figure 2. Portable chest x-ray performed 3 months after her presentation with Candida esophagitis.
A thoracic CT is performed after the chest x-ray is reviewed (Figure 3).
Figure 3. Representative images from the thoracic CT scan in lung windows.
What should be done next? (Click on the correct answer to proceed to the fourth of six pages)