B72-49 Tracheal Tragedy in Coal Worker: A Rare Case of Blastomycosis Involving the Trachea in Coal Worker’s Pneumoconiosis

Abstract A 64-year-old male from southwest Virginia, a former coal miner with CWP, tobacco use, and sleep apnea but no exposure to birds or pets presented with a six-month history of worsening cough, shortness of breath, and neck pain. Patient’s symptoms failed to improve with numerous treatment courses of systemic steroids and antibiotics. Chest X-ray showed calcified mediastinal and hilar lymphadenopathy(Image A). CT scan suggested a cluster of nodules in the left lower lobe measuring 14 mm with subsegmental atelectasis and scarring at the right upper lobe. (Image B). Bronchoscopy was performed due to progressive symptoms not responsive to conservative therapies, revealing tracheal mass, and subsequent biopsy was obtained (Image C). Biopsy showed a yeast form consistent with blastomycosis on GMS and PNS stain (Image E and F). Patient was treated with oral Itraconazole significantly reducing the morbidity.A discussion of the novelty and importance of the case(s):Tracheal involvement, a rare manifestation of blastomycosis, is rarely reported in a patient with CWP, presenting a unique intersection of occupational and infectious lung disease. Due to immune dysfunction in CWP, the effect of steroids led to patients being increasingly prone to endemic infections such as mycobacteria and fungi. However, the imaging abnormalities seen with CWP are difficult to distinguish from endemic fungal infection and it may be overlooked. Early diagnosis with Bronchoscopy and subsequent biopsy is the diagnostic step, which will enable timely initiating of antifungal and prevent subsequent morbidity. This abstract is funded by: None