Extrapulmonary Coccidioidomycosis in a Young Postpartum Immunocompetent Host

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Critical Care Medicine





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Introduction: Coccidioidomycosis is a common fungal infection, caused by Coccidioides immitis, that is endemic to the southwestern United States. Coccidioidomycosis commonly afflicts immunocompromised patients, and symptomatically presents with a variety of symptoms, depending upon the degree of immunodeficiency, which run the gamut from mild respiratory symptoms to refractory septic shock. Here, we report a case of disseminated coccidioidomycosis in a young post-partum female. Methods: A 26-year-old female with no significant past medical history presented to our hospital complaining of a one-month history of fevers, chills, weight loss, fatigue, and abdominal pain. Physical examination revealed a thin female in moderate distress with two pedunculated facial skin masses. Laboratory studies were suggestive of anemia with a hemoglobin of 7.9 g/dL, absolute eosinophilia, elevated transaminases, and disseminated intravascular coagulation. CT of the abdomen and pelvis revealed hepatosplenomegaly and splenic lesions suggestive of malignancy. Initially, the patient underwent urine and blood cultures, which were unrevealing. Due to the patient’s absolute eosinophilia, skin findings, and CT findings, bone marrow biopsy was obtained, without significant findings. Unfortunately, the patient continued to symptomatically worsen, and developed lactic acidosis and respiratory distress which required intubation and mechanical ventilation. Thereafter, the patient underwent biopsy of her skin lesions, which revealed evidence of coccidioides immitis infection. The patient was begun on Amphotericin B, without significant improvement. During that time, the patient continued to worsen, developing renal failure and lactic acidosis requiring continuous renal replacement therapy, septic shock requiring stress dose steroids, pressers/inotropes, and liver failure. Ultimately, the patient developed refractory hypoxemia and septic shock, and expired. Results: This case is significant because it highlights the severity of symptoms with which disseminated coccidioidomycosis can present, even in immunocompetent patients. It is imperative that physicians practicing in areas endemic to Coccidioides immitis be aware of the myriad, and severity, with which coccidioidomycosis may present.


Internal Medicine | Pulmonology



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