SHM Converge Scientific Abstract ePoster Gallery-Mass-Ive Deception: A Case of Abdominal Distention in a Teenager

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A 13-year-old South Sudanese girl with poorly controlled type 1 diabetes presented with one month of progressive abdominal distension and mild discomfort. She had no fever, vomiting, diarrhea, bleeding, travel, or respiratory symptoms, and two prior urgent care visits were unrevealing. Exam showed a markedly distended, firm, non-tender abdomen. Initial labs were largely normal except for an elevated CA-125, which raised concern for ovarian malignancy.<br /><br />She was admitted to oncology and underwent paracentesis and diagnostic laparoscopy. Imaging and operative findings suggested disseminated intra-abdominal disease: ascites, omental caking, peritoneal nodules, and a firm left ovarian mass containing pus. Because malignancy seemed likely, port placement for chemotherapy was considered, but this was deferred after further evaluation. Infectious Disease was consulted, and disseminated peritoneal coccidioidomycosis was diagnosed. Serum coccidioides titer was markedly elevated at 1:256. Lumbar puncture and bone scan were negative, and biopsy showed granulomatous inflammation with Coccidioides organisms and no malignancy.<br /><br />She was treated with two weeks of intravenous amphotericin B followed by long-term fluconazole. The case highlights that coccidioidomycosis, an endemic fungal infection in the Southwestern United States, can disseminate—especially in immunocompromised patients and those of African or Filipino ancestry. It also illustrates the danger of anchoring bias: early assumptions of cancer led to consideration of an unnecessary invasive procedure, which was avoided through multidisciplinary discussion.

Asset Subtitle

Nehal Thakkar

Meta Tag

Author List Emma Schnuckle, Keifer McKenna, Nehal Thakkar

Category Clinical Vignettes

Concept Disseminated Coccidioidomycosis

Concept Extrapulmonary Involvement

Concept Peritoneal Disease

Concept Differential Diagnosis

Concept Malignancy

Distinguished Non-Finalist

Presenter Organization Phoenix Childrens

Presenting Author Nehal Thakkar

Track Pediatric

Keywords

coccidioidomycosis

disseminated fungal infection

peritoneal disease

ovarian mass

ascites

CA-125 elevation

type 1 diabetes

amphotericin B

fluconazole

anchoring bias

Disseminated Coccidioidomycosis

Extrapulmonary Involvement

Peritoneal Disease

Differential Diagnosis

Malignancy