The Utility of Fine Needle Aspiration for Diagnosis of Extrapulmonary Coccidioidomycosis: A Case Report and Discussion

Disseminated coccidioidomycosis with molluscum-like lesions, diffuse lymphadenopathy, and splenomegaly in an immunocompetent patient

“…Symptomatology ranges from mild to severe, with the latter defined by the need for hospitalization 8–10. Pulmonary involvement is most frequent and includes pneumonia, pleural effusion, hilar lymphadenopathy, and lung nodules 2. Acute respiratory infection occurs about 1–3 weeks postinhalation, manifesting with typical symptoms of community-acquired respiratory illness, such as fever, headache, productive cough, fatigue, and pleuritic chest pain, with increased severity of headache and pleuritic chest pain suggesting coccidioidal infection 1,11…”

“…Coccidioidomycosis most commonly disseminates to the skin hematogenously,2,13 manifesting several weeks after the primary pulmonary infection12 as papules, nodules, verrucous plaques, pustules, and sinus tracts 13,14. Disseminated skin infection is typically nodular11 occurring on the face, neck, scalp, and chest wall,15,16 with the nasolabial folds being the most frequent location 13,17,18.…”

“…Symptomatic infection most commonly presents as pneumonia, but lymphatic and hematogenous disseminations can produce extrapulmonary illness in <5% of cases 1. Dissemination is most common to the skin, soft tissue, central nervous system, and bone 2. Immunosuppressed persons and individuals of African-American and Filipino descents are at a particularly high risk of disseminated disease 3…”

The Coccidioidomycosis Conundrum: A Rare Parotid Mass

“…20 In patients presenting similarly to this case with suitable masses, fine-needle aspiration biopsy can be a critical step in diagnosis and has previously been documented as an effective tool for diagnosis of extrapulmonary coccidioidomycosis. 21 On the basis of the 2005 Infectious Diseases Society of America published guidelines on coccidioidomycosis, oral azole antifungal agents are customary initial drugs of choice. Although ketoconazole has been approved for the treatment of coccidioidomycosis by the US Food and Drug Administration, studies have shown similar efficacy for use of fluconazole 22 or intraconazole 23 for chronic pulmonary and soft-tissue coccidioidal lesions.…”

Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children

“…CSF eosinophilia may also be present. The observation of distinctive spherules containing endospores in histopathologic tissue 37 or other clinical specimens is diagnostic. Stains of CSF in patients with meningitis usually are negative.…”