Coccidioidomycosis Mimicking Ovarian Cancer

Abstract

Peritoneal coccidioidomycosis can present with the clinical, radiographic, and serologic features of ovarian cancer. Although essential for diagnosis and staging, radiographic studies and tumor markers have limited specificity. Coccidioidomycosis now joins other benign conditions that comprise the differential diagnosis of patients who present with what seems to be advanced ovarian carcinoma. Infectious diseases consultation is recommended for the management of peritoneal coccidioidomycosis.

Elevated tumor markers in coccidiomyocosis of the female genital tract

“…It has been postulated that chronic inflammation causes an epithelial reaction that results in the leakage of the tumor markers into the circulation (14,15). Endometriosis due to a variety of infectious etiologies can cause serum CA 125 levels to be elevated and they can precipitously decrease following surgical intervention, as in our patient (4,5). CA 19-9 levels have also been found to return to normal following surgical intervention for endometriosis (16).…”

“…In those cases of Coccidioides involving the genital tract, there was no combination of investigations or clinical features that were sensitive enough to diagnose the female genital tract infection preoperatively. In fourteen of the eighteen patients (including our patient) with Coccidioides serologic test results, thirteen had a positive titer of 1:16 or greater (3)(4)(5)(6).…”

“…In this patient the response was to antifungal therapy rather than chemotherapy. We believe the tumor markers were elevated due to the inflammatory response to the Coccidioides infection (4,9). CA 125 is most commonly monitored in the management of ovarian carcinoma.…”

Coccidioidomycosis Masquerading as Eosinophilic Ascites

“…Involvement of the abdomen, however, is rare and was first reported in 1939 by Ruddock and Hope [ 13 ]. The presentation of IAC is nonspecific and generally imitates other infections or malignancy and the diagnosis mainly relies on tissue examination [ 4 , 5 , 14 ].…”

“…Therefore, a bone marrow biopsy was added to the plan; however, it was never done since the patient's clinical condition continued to improve on SBP treatment. In retrospect, our concern for malignancy was grounded since there is evidence that extrapulmonary coccidioidomycosis can occasionally mimic symptoms of an occult malignancy with operative findings of an inflamed peritoneum that is studded with nodular lesions [ 4 , 5 ]. We later added steroids to the treatment as lingering suspicion for EGE still remained.…”