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Pneumothorax in a young man in Brooklyn, New York.

Diagnosis: Pneumothorax from Rupture of a Coccidioidal Pulmonary Cavity Biopsy specimens (Figures 1 and 2) showed necrotizing granulomata containing 30to 40-lm thick-walled, nonbudding spherules revealed on Gomori methenamine silver stain (Figure 2). Results of stains for acid-fast bacilli were negative. Coccidioides immunoglobulin G (IgG) antibody was detected by means of immunodiffusion. Liposomal amphotericin B (AmBisome, Astellas Pharma) 5 mg/kg/day was given. On day 9 of the treatment, the patient developed right upper quadrant tenderness and elevated serum levels of transaminases. Sonogram of the liver was unremarkable, and viral hepatitis serological test results were negative. Liposomal amphotericin B was discontinued, and fluconazole 800 mg daily was started. Liver enzyme levels began to improve 2 days after discontinuation of amphotericin and were normal after 6 weeks.