USMLE PRACTICE QUESTION OF THE WEEK
Question for January 11, 2026
A 25-year-old man presents with a 10-day history of fever, chills, night sweats, and pleuritic chest pain. He recently returned from a backpacking trip in Arizona. He denies IV drug use. Exam shows a new systolic murmur at the left sternal border and tender nodules on the pads of his fingers. His chest x-ray reveals multiple small cavitary lesions in both lungs. Blood cultures grow yeast that form spherules with endospores.
Which of the following is the most appropriate treatment for this patient?
Which of the following is the most appropriate treatment for this patient?
Correct Answer:
A. Amphotericin B
Correct Answer Explanation:
This patient has disseminated coccidioidomycosis with endocarditis and pulmonary cavitations. Initial therapy for severe disseminated or CNS disease is amphotericin B, with azole therapy used for step-down treatment. Fluconazole/itraconazole are used in milder cases. Caspofungin covers Candida and Aspergillus, not Coccidioides.
Further Insight:
- Coccidioides endemic in Southwest US.
- Risk increases with immunosuppression or large inoculum exposure.