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Platypnea-orthodeoxia — ABIM Board MCQ

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HardPulmonary/Critical CarePlatypnea-orthodeoxiaABIM Board

A 41-year-old Arizona resident has headache, diplopia, lymphocytic meningitis, low CSF glucose, and positive CSF Coccidioides antibody. He improves on high-dose fluconazole and has no hydrocephalus. After three years he asks when therapy can stop. Which recommendation is most appropriate?

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Reveal the answer and explanation

Correct answer: D — Continue lifelong azole therapy with toxicity and interaction monitoring

The best answer is “Continue lifelong azole therapy with toxicity and interaction monitoring”. Coccidioidal meningitis is suppressed rather than reliably eradicated by azoles, and relapse rates after discontinuation are high. IDSA therefore recommends lifelong azole therapy when effective and tolerated. Clinical response, CSF trends, drug interactions, hepatic toxicity, and complications such as hydrocephalus still require follow-up. A single reassuring CSF result or prolonged symptom-free interval does not make cessation safe, and antibacterial therapy is irrelevant.

Reference: IDSA Guideline: Treatment of Coccidioidomycosis: https://www.idsociety.org/practice-guideline/coccidioidomycosis/