Peritoneal and genital coccidioidomycosis in an otherwise healthy Danish female: a case report

Abstract

BackgroundCoccidioidomycosis is a fungal infection that usually presents as a primary lung infection. The fungus is endemic to the Southwest United States of America, northern Mexico and parts of Central and South America the infection is rare outside these areas. However, some patients develop disseminated infection that can lie dormant for several years and can present itself in travelers. We report the first case of extra pulmonary Coccidioidomycosis in a non-immunocompromised individual in Denmark.Case presentationA 32 year old Danish woman presented at the Emergency department with abdominal pain. Computed tomography scan and ultrasound examination of the pelvis raised suspicion of salpingitis. A laparoscopy exposed a necrotic salpinx and several small white elements that resembled peritoneal carcinomatosis. Histological workup however determined that she suffered from disseminated coccidioidomycosis. The patient had lived 2 years in Las Vegas, in the United States of America, 7 years prior and had no memory of lung infection at the time.ConclusionsDisseminated coccidioidomycosis is rare in non-immunocompromised individuals. The patient in this case underwent several rounds of in vitro fertilization treatment in the years before admittance. We suspect that the hormonal treatment in combination with low-dose prednisolone may have triggered reemergence of the disease and present literature that support this.

Diagnosis of disseminated coccidioidomycosis in pregnancy through placental pathology: A case report

“…This argument is bolstered by the fact that this patient had had no prior risk factors for intraabdominal adhesions such as pelvic inflammatory disease or intraabdominal surgery. There have been two other case reports of women with unexplained infertility who were subsequently diagnosed with pelvic coccidioidomycosis [ 19 , 20 ].…”

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

“…Our case highlights a possible association between hormonal changes with fertility treatment, immune tolerance in pregnancy, and risk for peritoneal coccidioidomycosis. Studies show that elevated serum levels of 17-beta-estradiol and progesterone in vitro increase coccidioidomycosis growth, contributing to dissemination [ 10 ]. Our patient received clomiphene citrate and was newly pregnant, thereby raising estradiol and progesterone levels.…”

“…In concordance, endometrial tissue was negative for coccidioidomycosis. In the only other report of disseminated coccidioidomycosis in a woman who underwent ovarian stimulation with clomiphene citrate and insemination, presentation was several years after fertility treatment [ 10 ].…”