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“I Feel Stuck:“ A Case Presentation on the Application of OMM to a Patient with Chronic Atypical Chest Pain After Pulmonary Coccidioidomycosis

Journal: The AAO Journal Date: 2025/06, 35(2):Pages: 18. doi: Subito , type of study: case report

Full text    (https://aaoj.kglmeridian.com/view/journals/aaoj/35/2/article-p13.xml)

Keywords:

case report [710]
chest pain [20]
chronic pain [296]
female [607]
OMT [3752]
osteopathic manipulative treatment [3772]
pneumonia [44]
pulmonary coccidioidomycosis [1]
valley fever [1]
women [562]

Abstract:

Introduction: Pulmonary coccidioidomycosis is a lung infection common in the southwestern region of the United States. Though most infections are asymptomatic or mild, it may become chronic with rare recurrence or dissemination. Treatment for long symptoms following infection from coccidioidomycosis is limited and thus the following application of osteopathic manipulative treatment (OMT) is an innovative approach. Case: D.K., a 44-year-old female, presented to the Midwestern University Multispecialty clinic with a chief complaint of brain fog, fatigue, and constant chest pain rated on a Numerical Rating Scale (NRS) of 7/10. Two years prior to her visit, she was diagnosed with coccidioidomycosis but was still unable to return to baseline. This case presentation will highlight her initial 5 visits. Results: Common osteopathic structural exam findings revealed several somatic dysfunctions of the upper thoracic and suboccipital regions. Differential diagnosis included obstructive pulmonary disease or long-post pneumonia symptoms. Pulmonary function tests were within normal range. NRS decreased from 7/10 to 5/10 in 4 visits, with symptom regression and an increase in length between visits. The COPD Assessment Tool was utilized to monitor symptoms and showed a slight decrease from 23 to 20 at visit five. Discussion: OMT consisted of an abbreviated protocol modeled after the one presented in the Multicenter Osteopathic Pneumonia Study in the Elderly (MOPSE) – a protocol that emphasizes thoracic mobility, increased lymphatic flow, and balancing of the autonomic nervous system. D.K. presented with symptoms similar to long-COVID following pulmonary coccidioidomycosis. Conclusion: Because treatment of long-pneumonia symptoms from coccidioidomycosis is not well described, the authors addressed D.K.’s symptoms using the MOPSE protocol as a treatment foundation. Application of OMT in patients experiencing long-pneumonia symptoms following coccidioidomycosis infection will require further research.


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