SHM Converge Scientific Abstract ePoster Gallery-Fateful Fall: A Rare Case of Disseminated Coccidiomycosis

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This case describes disseminated coccidioidomycosis in a 50-year-old Hispanic man from Mexico with major risk factors for severe fungal infection: chronic steroid use for osteoarthritis and type II diabetes. He presented with generalized weakness and a fall, and exam revealed verrucous and nodular skin lesions on the right arm, posterior neck, and left thumb. Initial neurologic and cardiac workup was unremarkable, but chest CT showed multiple bilateral cavitary lung lesions concerning for infection, and knee imaging showed a suprapatellar effusion.<br /><br />Further evaluation by infectious disease, dermatology, and orthopedics confirmed disseminated Coccidioides immitis infection. Key findings included positive Coccidioides antibodies by immunodiffusion, a very elevated complement fixation titer of 1:256, fungal culture from the right knee growing Coccidioides immitis, and a PAS-positive skin biopsy. Lumbar puncture was negative, indicating no CNS involvement.<br /><br />The patient was started on fluconazole 800 mg daily with a plan for at least one year of treatment. He also underwent right knee arthrotomy with irrigation, debridement, and drainage for fungal septic arthritis, tolerated the procedure well, and was discharged to a skilled nursing facility.<br /><br />The report highlights that Coccidioides immitis is a soil-dwelling dimorphic fungus endemic to the southwestern United States, northern Mexico, and parts of Central and South America, typically acquired by inhalation of spores. While many infections are asymptomatic, disseminated disease is rare and occurs more often in immunocompromised patients. The case emphasizes the importance of careful history, physical examination, and clinical suspicion to avoid delayed diagnosis and serious complications.

Asset Subtitle

Nariman Khan

Meta Tag

Author List Nariman Khan

Category Clinical Vignettes

Concept Coccidioides immitis

Concept Coccidioidomycosis

Concept Disseminated infection

Concept Immunosuppression

Concept Corticosteroid Use

Distinguished Non-Finalist

Presenter Organization Uthscsa

Presenting Author Nariman Khan

Track Adult

Keywords

disseminated coccidioidomycosis

Coccidioides immitis

fungal septic arthritis

chronic steroid use

type II diabetes

cavitary lung lesions

verrucous skin lesions

complement fixation titer

fluconazole treatment

endemic fungal infection

Coccidioides immitis

Coccidioidomycosis

Disseminated infection

Immunosuppression

Corticosteroid Use