Intensive Care Medicine (ICM) Practice Exam

Your patient, a marathon runner from Arizona, presents with chronic fatigue and joint pain after a recent trip. What is the best diagnosis given their symptoms?

1. Legionnaire's disease

2. Pontiac fever

3. Mycoplasma pneumonia

4. Coccidiomycosis

The correct answer is: Coccidiomycosis

Coccidiomycosis is the most appropriate diagnosis in this case due to the patient's background as a marathon runner from Arizona, which is an endemic region for the fungus Coccidioides immitis. This fungus is commonly found in the southwestern United States and can lead to respiratory illness upon inhalation of its spores. The symptoms of chronic fatigue and joint pain align with the atypical manifestations of the disease, which can occur in some individuals after they have been exposed to the fungus. Acute pulmonary symptoms are typically present as well, but in some cases, it can lead to chronic complications and systemic infection, resulting in symptoms that include fatigue and arthralgias. The other options, while they can be serious infections, are less consistent with the geographical and symptomatic context provided. Legionnaire's disease and Mycoplasma pneumonia are more associated with respiratory illness and do not typically cause chronic joint pain. Pontiac fever is a milder illness caused by Legionella bacteria without the severe outcomes seen in Legionnaire’s disease, and it typically does not lead to chronic symptoms. Therefore, Coccidiomycosis stands out as the diagnosis that best accounts for the patient's recent travel history and cluster of symptoms.