SHM Converge Scientific Abstract ePoster Gallery-An Infectious Disguise; Disseminated Coccidioidomycosis Masking Hairy Cell Leukemia

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This case report describes a 60-year-old man whose initial presentation of fever, chills, diarrhea, cough, weakness, hypotension, and septic shock was caused by disseminated coccidioidomycosis. He was found to have positive coccidioidal blood titers and imaging showing a pulmonary nodule and severe splenomegaly. Despite treatment with fluconazole, he did not improve and remained neutropenic with longstanding pancytopenia noted in prior outpatient records.<br /><br />Further evaluation, including bone marrow biopsy, revealed two key findings: disseminated Coccidioides spherules and involvement by hairy cell leukemia, a rare chronic B-cell malignancy. The marrow showed patchy interstitial infiltrates of bland hairy cells and positive B-cell immunohistochemical markers, supporting the diagnosis.<br /><br />The report emphasizes that the patient’s underlying hairy cell leukemia likely caused chronic neutropenia and immunocompromise, predisposing him to severe disseminated fungal infection. At the same time, the overwhelming infectious presentation obscured the underlying malignancy, delaying diagnosis. The case highlights how disseminated coccidioidomycosis can mask an occult hematologic cancer and underscores the importance of considering bone marrow biopsy in patients with unexplained chronic cytopenias, splenomegaly, or persistent neutropenia.<br /><br />Ultimately, the patient was transferred to Mayo Clinic for inpatient chemotherapy.

Asset Subtitle

Anna E. Schwab

Meta Tag

Author List Aaron Sidhu, Anna E. Schwab, Ava Koehler De Celaya, Hina Humayun, James Choi, Kirk Thorpe, Serene Musallam

Category Clinical Vignettes

Concept Hairy Cell Leukemia

Concept Disseminated Coccidioidomycosis

Concept Bone Marrow Biopsy

Concept Chronic Pancytopenia

Concept Thick-Walled Spherule

Distinguished Non-Finalist

Presenter Organization Abrazo

Presenting Author Anna E. Schwab

Track Adult

Keywords

disseminated coccidioidomycosis

hairy cell leukemia

septic shock

bone marrow biopsy

splenomegaly

neutropenia

pancytopenia

fungal infection

hematologic malignancy

immunocompromise

Hairy Cell Leukemia

Disseminated Coccidioidomycosis

Bone Marrow Biopsy

Chronic Pancytopenia

Thick-Walled Spherule