SHM Converge Scientific Abstract ePoster Gallery-Disseminated Coccidioidomycosis Presenting as Ascites: Case Report

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This poster presents a rare case of disseminated coccidioidomycosis (Valley Fever) causing ascites. A 61-year-old Hispanic man with end-stage renal disease on hemodialysis and type 2 diabetes developed two months of progressive abdominal pain, distension, anorexia, and intermittent fevers. He had lived in Fresno, California, an endemic area, for over 20 years and had been treated for COVID-19 pneumonia five months earlier.<br /><br />Workup showed leukocytosis and markedly elevated alkaline phosphatase, with mild liver enzyme elevation. Tumor markers and HIV testing were negative. CT and MRI revealed large-volume ascites, a small right pleural effusion, and multiple pulmonary nodules. Paracentesis showed lymphocyte-predominant fluid, but routine bacterial and acid-fast studies were negative. Because of the unexplained ascites and lung nodules, coccidioidomycosis testing was performed and was strongly positive, with IgG and IgM antibodies and a complement fixation titer of 1:256, indicating disseminated disease.<br /><br />The patient was treated with oral fluconazole and improved within three weeks, with significant reduction in ascites and better appetite, mood, and fever resolution.<br /><br />The discussion emphasizes that coccidioidomycosis usually causes mild pulmonary illness, while disseminated infection occurs in less than 1% of exposed individuals. Peritoneal involvement is especially rare and can mimic other causes of ascites such as portal hypertension, malignancy, or nephrotic syndrome. The authors highlight the importance of considering this diagnosis in endemic regions to prevent misdiagnosis and unnecessary testing. Fluconazole is noted as first-line therapy for many forms of coccidioidomycosis.

Asset Subtitle

Yudhveer Brar

Meta Tag

Author List Nhia R. Yang, Seyed Ali Mohammadi Rad, Yudhveer Brar

Category Clinical Vignettes

Concept Coccidioidomycosis

Concept Fluconazole

Concept Disseminated infection

Concept Complement Fixation Titer

Concept Endemicity

Distinguished Non-Finalist

Presenter Organization St Agnes Medical Center Internal Medicine Residency

Presenting Author Yudhveer Brar

Track Adult

Keywords

coccidioidomycosis

Valley Fever

disseminated infection

ascites

fluconazole

pulmonary nodules

endemic region

peritoneal involvement

hemodialysis

diabetes

Coccidioidomycosis

Fluconazole

Disseminated infection

Complement Fixation Titer

Endemicity