Unusual Presentations of Coccidioidomycosis

Abstract

Coccidioidomycosis is an emerging fungal infection of the southwestern United States. Although Coccidioides species infections are usually asymptomatic or result in a mild, flu-like illness, disseminated disease may occur in 1% of cases. While extrapulmonary disease usually involves the skin, central nervous system, bones, or joints, coccidioidomycosis is a great imitator, with the ability to infect any tissue or organ. Cases may be diagnosed outside of endemic areas, hence providers worldwide should be aware of the broad range of manifestations of coccidioidomycosis. We present a case series of unusual presentations of coccidioidomycosis including serous cavity infections with cases of pericarditis, empyema, and peritonitis, as well as unusual abscesses involving the retropharyngeal space and gluteal musculature. We provide a complete review of the literature and summarize the clinical presentations, diagnoses, and treatments of these rare forms of disseminated coccidioidomycosis.

Elevated tumor markers in coccidiomyocosis of the female genital tract

“…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).…”

“…However, transmission from a man with prostate involvement to a woman who developed an infection of her genital tract could occur, but our patient's husband had no prostate disease, no history of Valley Fever and his Coccidioides serology was negative. Coccidioides has been documented to mimic a variety of malignancies such as breast cancer, bronchogenic carcinoma, osteosarcoma and lymphoma (6). It is notable that the first reported case of coccidioidomycosis in 1892 was initially misdiagnosed as mycosis fungoides (6).…”

An 18-Year-Old Man With Bilateral Violaceous Cervical Adenopathy

“…5 Quantitative testing of coccidioidal IgG titers are determined by complement fixation and can be detected between weeks 2 and 28. 2,6 Low complement fixation titers suggest a favorable prognosis, whereas titers greater than 1:16 portend disseminated disease. 7 A definitive diagnosis is made with tissue biopsy and fungal cultures.…”

“…10 Treatment of nonmeningeal disseminated coccidioidomycosis should continue for at least 1 year and until evidence of infection is resolved. 6 Patients with osseus lesions require a longer duration of therapy. During treatment, complement fixation titers should be checked every 3 to 6 months.…”

Disseminated Coccidioidomycosis Presenting as Carcinomatosis Peritonei and Intestinal Coccidioidomycosis in a Patient with HIV

“…There are approximately 35 cases of peritoneal seeding but there are only 4 reported cases in the literature of CM to the terminal ileum [10]. Out of these 4 reported cases, only 2 patients had HIV [11].…”