Coccidioidomycosis in pregnancy: Case report and literature review of associated placental lesions

Abstract

BackgroundCoccidioidomycosis is an endemic fungal infection found most commonly in the Southwestern United States, Northwestern Mexico, and parts of Central and South America. Although infection is relatively uncommon during pregnancy, it is imperative to have an index of suspicion in order to diagnose and begin timely treatment to prevent dissemination and dire consequences.Case reportA 33-year-old Hispanic female was evaluated after she was involved in an automobile accident. Radiographic evaluation showed a 3.2 × 3.2 cm cavitary thick-walled lesion. A biopsy was negative for malignancy. Evaluation was positive for coccidioidomycosis by complement fixation reaction. Four months later, the patient presented 7 weeks into a pregnancy with massive hemoptysis. Bronchoscopy revealed bleeding from the right upper lobe and emergency embolization was performed. The patient had a spontaneous abortion 9 days after admission. The right upper and middle lobes of the lung were resected due to continuous bleeding. A subsequent pregnancy was un-eventful. Coccidioidomycosis titers remained negative throughout the second pregnancy.DiscussionThis case demonstrates the potential for severe pulmonary coccidioidomycosis and vascular strain of pregnancy-associated vascular expansion in the first trimester of pregnancy and the possibility of a favorable pregnancy outcome in subsequent pregnancies after appropriate treatment. The route of feto-maternal transmission and placental lesions in coccidioidomycosis are discussed.

Disseminated peritoneal coccidioidomycosis in pregnancy following fertility treatment: A case report and literature review

“…In our patient's case, it is possible that the immune-tolerance effects of pregnancy or the hormonal effects of ovarian stimulation may have contributed to her acute presentation. Prior data report pregnant women experience disseminated disease 100 times more frequently [ 2 , 6 ].…”

“…Going forward, our patient may have a small but increased risk of disease reactivation in future pregnancies. There is a lack of literature guiding reproductive patients for timing and risk of future conception [ 6 , 14 ]. According to the Infectious Disease Society of America guidelines, risk of reactivation in pregnancy is low in women who have completed therapy [ 3 ].…”

“…Prior data have shown that disseminated disease occurs in 23% of pregnant patients in the first trimester [ 5 ]. Extrapulmonary disease occurs most commonly in soft tissue, skin, joints and brain [ 6 ]. In contrast, peritoneum dissemination is rare, occurring through hematogenous spread or swallowing pulmonary secretions [ 7 ].…”

Hellp Syndrome With Placental Abruption and Fetal Death: A Case Report

“…Therefore, we can consider that the hypoxia, caused by both the syndrome pathogeny and the PA, led to the fetal death. The leukocytosis observed in D1 could be due to the current UTI, associated with the fetal death 15 . Although discrete, the transaminases are related to the hepatic involvement, associated with an impaired renal function and the cell lysis, evidenced by LDH elevation and a severe thrombocytopenia.…”

Pulmonary Coccidioidomycosis

“…38,50 Cases of both maternal and fetal death from disseminated coccidioidomycosis have been reported. 80,81 Pregnant patients should be treated with the antifungal agent amphotericin B, which has been shown to decrease mortality associated with disseminated coccidioidal infection. 70 All azoles have C or D classifications from the U.S. Food and Drug Administration because of potential teratogenic effects to the early fetus.…”