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Gharakhanian R, Ohno A, Craig D, Wang S. Valley fever, mimicker of malignancy. Heliyon 2023; 9:e12900. [PMID: 36685442 PMCID: PMC9851880 DOI: 10.1016/j.heliyon.2023.e12900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Coccidioidomycosis rates in endemic areas such as California and Arizona have been increasing in recent years. Most common manifestations in symptomatic individuals involve the lungs. Disseminated disease occurs when the infection spreads beyond the lungs. Disseminated disease occurs in about 1% of all coccidiomycosis cases. Diagnosis in classically non-endemic regions can be difficult as coccidiomycosis can mimic a variety of other illnesses which can lead to delays in initiating appropriate therapy. We report a case of severe disseminated coccidiomycosis involving the soft tissue, bone, and intra-abdominal organs in a previously healthy individual that was initially thought to be a malignancy. With climate change possibly altering the traditional endemic regions and expanding Coccidioides to new territories, this case reinforces the importance of maintaining a broad differential as well as awareness of disease manifestations for healthcare providers who do not regularly treat Coccidioides.
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Affiliation(s)
- Raffi Gharakhanian
- Arrowhead Regional Medical Center, Department of Internal Medicine and Infectious Diseases, 400 N Pepper Ave., Colton, CA 92324, USA,Corresponding author.
| | - Ai Ohno
- California University of Science and Medicine School of Medicine, 1501 Violet St., Colton, CA 92324, USA
| | - Debra Craig
- Arrowhead Regional Medical Center, Department of Internal Medicine and Infectious Diseases, 400 N Pepper Ave., Colton, CA 92324, USA,California University of Science and Medicine School of Medicine, 1501 Violet St., Colton, CA 92324, USA
| | - Sharon Wang
- Arrowhead Regional Medical Center, Department of Internal Medicine and Infectious Diseases, 400 N Pepper Ave., Colton, CA 92324, USA
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2
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Szvalb AD, Yepez Guevara E, Euscher E, Nahmod KA, Kontoyiannis DP. Acute Peritoneal Histoplasmosis Mimicking Ovarian Cancer and Review of the Literature on Histoplasma Peritonitis. Open Forum Infect Dis 2023; 10:ofac705. [PMID: 36686636 PMCID: PMC9850267 DOI: 10.1093/ofid/ofac705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/08/2023] [Indexed: 01/11/2023] Open
Abstract
Peritoneal histoplasmosis is a rare entity with few cases reported in the literature. We present a case of isolated acute peritoneal histoplasmosis that mimicked an advanced ovarian malignancy in a patient undergoing antitumor necrosis factor therapy for rheumatoid arthritis. We also reviewed the literature on Histoplasma peritonitis.
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Affiliation(s)
- Ariel D Szvalb
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Yepez Guevara
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elizabeth Euscher
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Karen A Nahmod
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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3
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Ke M, Heidari A, Valdez M, Tsiyer A, Kuran R, Johnson R. A Case of Concurrent Disseminated Coccidioidomycosis and Embryonal Carcinoma When Lice and Fleas Coexist. J Investig Med High Impact Case Rep 2022; 10:23247096221098339. [PMID: 35567302 PMCID: PMC9109491 DOI: 10.1177/23247096221098339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/16/2022] [Accepted: 04/16/2022] [Indexed: 11/15/2022] Open
Abstract
Coccidioidomycosis (CM) is a fungal infection endemic to the southwestern United States with a wide range of clinical presentations depending on the infected organ systems. Most infections are asymptomatic. Coccidioidomycosis causes a primary pulmonary infection and when symptoms occur, they most often resemble community-acquired pneumonia. One percent of cases disseminate, typically via hematogenous or lymphatic spread. It is in these cases that more severe symptoms may present and potentially overlap with those characteristics of other systemic illnesses. This is a case of CM disseminated to lymph nodes in a 24-year-old man with concomitant metastatic embryonal carcinoma. It is difficult to identify the primary etiology for many components of this patient's presentation, including diffuse lymphadenopathy and multiple pulmonary nodules. Furthermore, the relationship between these 2 concurrent disease processes is not entirely clear. Factors that may contribute include the well-known phenomenon of locus minoris resistentiae (LMR) or potentially a shared immune failure between infectious organisms and malignant cells.
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Affiliation(s)
- Michael Ke
- Department of Internal Medicine, Division of
Infectious Diseases, UCLA at Kern Medical Center, Bakersfield, CA, USA
- Valley Fever Institute, Bakersfield, CA,
USA
| | - Arash Heidari
- Department of Internal Medicine, Division of
Infectious Diseases, UCLA at Kern Medical Center, Bakersfield, CA, USA
- Valley Fever Institute, Bakersfield, CA,
USA
| | - Michael Valdez
- Department of Internal Medicine, UCLA at Kern
Medical Center, Bakersfield, CA, USA
| | - Allen Tsiyer
- Department of Internal Medicine, UCLA at Kern
Medical Center, Bakersfield, CA, USA
| | - Rasha Kuran
- Department of Internal Medicine, Division of
Infectious Diseases, UCLA at Kern Medical Center, Bakersfield, CA, USA
- Valley Fever Institute, Bakersfield, CA,
USA
| | - Royce Johnson
- Department of Internal Medicine, Division of
Infectious Diseases, UCLA at Kern Medical Center, Bakersfield, CA, USA
- Valley Fever Institute, Bakersfield, CA,
USA
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4
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Abigail A, Mika W, Debika B, Mae Z, Lindsay K. Disseminated peritoneal coccidioidomycosis in pregnancy following fertility treatment: A case report and literature review. Case Rep Womens Health 2021; 30:e00299. [PMID: 33665141 PMCID: PMC7905336 DOI: 10.1016/j.crwh.2021.e00299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 11/18/2022] Open
Abstract
Disseminated peritoneal coccidioidomycosis in the setting of early pregnancy after fertility treatment is rare and can present as a diagnostic challenge. A 39-year-old underwent ovarian stimulation with clomiphene citrate followed by HCG trigger and intrauterine insemination. She developed persistent abdominal pain, ascites and episodes of fever in early pregnancy, and eventually underwent a diagnostic laparoscopy for worsening clinical presentation. Operative findings were notable for peritoneal studding, infracolic omentum inflammation, bowel adhesions to the abdominal wall and normal-appearing uterus and adnexa. The pathology results indicated peritoneal Coccidioides immitis infection. Hormonal changes associated with fertility treatment and immune tolerance in pregnancy may increase the risk for disseminated peritoneal coccidioidomycosis. A high index of suspicion and a multidisciplinary team are important for the diagnostic workup and treatment plan of disseminated peritoneal coccidioidomycosis.
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Affiliation(s)
- Armstrong Abigail
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of California Los Angeles, USA
- Corresponding author at: 200 UCLA Medical Plaza #220, Los Angeles, CA 90095, USA.
| | - Watanabe Mika
- Department of Internal Medicine, Division of Infectious Disease, University of California Los Angeles, USA
| | - Bhattacharya Debika
- Department of Internal Medicine, Division of Infectious Disease, University of California Los Angeles, USA
| | - Zakhour Mae
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California Los Angeles, USA
| | - Kroener Lindsay
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of California Los Angeles, USA
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5
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Tafti D, Krause K, Dillon R, Flores R, Cecava ND. Sigmoid cancer mimicking ovarian echotexture on transvaginal ultrasound: Case report with literature review. Radiol Case Rep 2020; 15:2482-2492. [PMID: 33014234 PMCID: PMC7522440 DOI: 10.1016/j.radcr.2020.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/15/2020] [Accepted: 09/20/2020] [Indexed: 11/29/2022] Open
Abstract
Ultrasound is a first line imaging modality for the evaluation of female pelvic pain. Pelvic pain constitutes one of the most common reasons for presentation to the emergency department with increasing use of point of care ultrasound. Infrequently, point of care or formal ultrasound evaluation may lead to misdiagnosis of extraovarian disease. This can have serious consequences, especially if an extraovarian malignancy is mistaken for a normal ovary or an ovary with a benign process. We present a case of a 41-year-old female who presented to the emergency department for a chief complaint of pelvic pain and vaginal bleeding. Transvaginal ultrasound demonstrated a left adnexal mass, later characterized as a sigmoid colon cancer on MRI and pathology, simulating ovarian echotexture with peripheral hypoechoic components resembling follicles. This article will review the literature of various cases of extraovarian pathology misidentified as ovarian processes and highlight the importance of considering these extraovarian mimickers to prevent potential morbidity and mortality of a missed diagnosis.
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Affiliation(s)
- Dawood Tafti
- Department of Radiology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, San Antonio, TX, 78234, USA
| | - Katherine Krause
- Department of Pathology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, San Antonio, TX, 78234, USA
| | - Rebecca Dillon
- Department of Radiology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, San Antonio, TX, 78234, USA
| | - Rebecca Flores
- Department of Radiology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, San Antonio, TX, 78234, USA
| | - Nathan D Cecava
- Department of Radiology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, San Antonio, TX, 78234, USA.,Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA.,Texas A&M School of Medicine, 8447 Riverside Pkwy, Bryan, TX 77807, USA
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6
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Bæk O, Astvad K, Serizawa R, Wheat LJ, Brenøe PT, Hansen ABE. Peritoneal and genital coccidioidomycosis in an otherwise healthy Danish female: a case report. BMC Infect Dis 2017; 17:105. [PMID: 28143444 PMCID: PMC5282638 DOI: 10.1186/s12879-017-2212-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coccidioidomycosis is a fungal infection that usually presents as a primary lung infection. The fungus is endemic to the Southwest United States of America, northern Mexico and parts of Central and South America the infection is rare outside these areas. However, some patients develop disseminated infection that can lie dormant for several years and can present itself in travelers. We report the first case of extra pulmonary Coccidioidomycosis in a non-immunocompromised individual in Denmark. CASE PRESENTATION A 32 year old Danish woman presented at the Emergency department with abdominal pain. Computed tomography scan and ultrasound examination of the pelvis raised suspicion of salpingitis. A laparoscopy exposed a necrotic salpinx and several small white elements that resembled peritoneal carcinomatosis. Histological workup however determined that she suffered from disseminated coccidioidomycosis. The patient had lived 2 years in Las Vegas, in the United States of America, 7 years prior and had no memory of lung infection at the time. CONCLUSIONS Disseminated coccidioidomycosis is rare in non-immunocompromised individuals. The patient in this case underwent several rounds of in vitro fertilization treatment in the years before admittance. We suspect that the hormonal treatment in combination with low-dose prednisolone may have triggered reemergence of the disease and present literature that support this.
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Affiliation(s)
- Ole Bæk
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.
| | - Karen Astvad
- Department of Microbiology and Infection Control, Statens Serum Institut, Unit of Mycology, Copenhagen, Denmark
| | - Reza Serizawa
- Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark
| | | | - Pia T Brenøe
- Department of Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Ann-Brit E Hansen
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
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Ramírez-Romero R, Silva-Pérez RA, Lara-Arias J, Ramírez-Hernández C, Marino-Martínez IA, Barbosa-Quintana Á, López-Mayagoitia A. Coccidioidomycosis in Biopsies with Presumptive Diagnosis of Malignancy in Dogs: Report of Three Cases and Comparative Discussion of Published Reports. Mycopathologia 2015; 181:151-7. [PMID: 26419685 PMCID: PMC4676787 DOI: 10.1007/s11046-015-9948-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/16/2015] [Indexed: 12/01/2022]
Abstract
Coccidioidomycosis is a respiratory fungal infection with occasional systemic dissemination. The disseminated coccidioidomycosis is considered a multifaceted disease. In medicine, disseminated coccidioidomycosis is included within a group of infectious diseases that have been referred as the great imitators. In many cases, malignancies are included in the presumptive diagnosis. In veterinary medicine, disseminated coccidioidomycosis is common in dogs. Nonetheless, despite of being a diagnostic dilemma, disseminated coccidioidomycosis is underestimated and frequently not included into differentials, even in endemic zones. Herein, we describe three cases of granulomatous inflammation caused by Coccidioides spp. which were masquerading malignancies in dogs (0.39 %). The presumptive diagnoses in these cases were osteosarcoma, lymphoma and neurofibroma, respectively. A PCR assay employing tissues in paraffin blocks resulted positive for C. posadasii in one of these cases. A comparative discussion on the ambiguous clinic-pathological presentation of disseminated coccidioidomycosis in dogs and humans is included.
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Affiliation(s)
- Rafael Ramírez-Romero
- Posgrado Conjunto Agronomía-Veterinaria, Facultad de Medicina Veterinaria y Zootecnia, Campus de Ciencias Agropecuarias, Universidad Autónoma de Nuevo León, Av. Francisco Villa s/n, Ex-Hacienda el Canadá, C.P. 66050, Gral. Escobedo, N.L., México.
| | - Rolando Antonio Silva-Pérez
- Posgrado Conjunto Agronomía-Veterinaria, Facultad de Medicina Veterinaria y Zootecnia, Campus de Ciencias Agropecuarias, Universidad Autónoma de Nuevo León, Av. Francisco Villa s/n, Ex-Hacienda el Canadá, C.P. 66050, Gral. Escobedo, N.L., México
| | - Jorge Lara-Arias
- Banco de Hueso y Tejidos, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, N.L., México
| | - Cecilia Ramírez-Hernández
- Posgrado Conjunto Agronomía-Veterinaria, Facultad de Medicina Veterinaria y Zootecnia, Campus de Ciencias Agropecuarias, Universidad Autónoma de Nuevo León, Av. Francisco Villa s/n, Ex-Hacienda el Canadá, C.P. 66050, Gral. Escobedo, N.L., México
| | - Iván Alberto Marino-Martínez
- Centro de Investigación y Desarrollo en Ciencias de la Salud (CIDICS), Universidad Autónoma de Nuevo León, Monterrey, N.L., México
| | - Álvaro Barbosa-Quintana
- Departamento de Anatomía Patológica, Hospital Universitario, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, N.L., México
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8
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Coccidioidomycosis Masquerading as Eosinophilic Ascites. Case Rep Gastrointest Med 2015; 2015:891910. [PMID: 26266062 PMCID: PMC4523687 DOI: 10.1155/2015/891910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/12/2015] [Indexed: 11/17/2022] Open
Abstract
Endemic to the southwestern parts of the United States, coccidioidomycosis, also known as "Valley Fever," is a common fungal infection that primarily affects the lungs in both acute and chronic forms. Disseminated coccidioidomycosis is the most severe but very uncommon and usually occurs in immunocompromised individuals. It can affect the central nervous system, bones, joints, skin, and, very rarely, the abdomen. This is the first case report of a patient with coccidioidal dissemination to the peritoneum presenting as eosinophilic ascites (EA). A 27-year-old male presented with acute abdominal pain and distention from ascites. He had eosinophilia of 11.1% with negative testing for stool studies, HIV, and tuberculosis infection. Ascitic fluid exam was remarkable for low serum-ascites albumin gradient (SAAG), PMN count >250/mm(3), and eosinophils of 62%. Abdominal imaging showed thickened small bowel and endoscopic testing negative for gastric and small bowel biopsies. He was treated empirically for spontaneous bacterial peritonitis, but no definitive diagnosis could be made until coccidioidal serology returned positive. We noted complete resolution of symptoms with oral fluconazole during outpatient follow-up. Disseminated coccidioidomycosis can present in an atypical fashion and may manifest as peritonitis with low SAAG EA. The finding of EA in an endemic area should raise the suspicion of coccidioidal dissemination.
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9
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Felder SI. Trauma sternotomy for presumed haemopericardium with incidental coccidioidal pericarditis. Trauma Case Rep 2015; 1:4-8. [PMID: 30101167 PMCID: PMC6082434 DOI: 10.1016/j.tcr.2015.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2015] [Indexed: 11/20/2022] Open
Abstract
Background Disseminated cocciodiomycosis with extrapulmonary disease occurs in less than 1% of infected patients, with few cases involving the pericardium reported in the literature. A subxiphoid window in a focussed assessment with sonography for trauma is a fast and reliable study for detecting haemopericardium in the haemodynamically unstable injured patient. Methods Case report and literature review. Case report A 50-year old man presented in extremis following a stab wound to the right thoracoabdominal region with a positive pericardial ultrasound. At the time of emergent sternotomy, the pericardial effusion appeared non-traumatic and not the cause of haemodynamic instability. Lung, diaphragm, liver and transverse colon lacerations were controlled by laparotomy. He was discovered to have extensive adenopathy within the mediastinum, porta hepatis, and lesser sac, which after histopathologic examination, demonstrated granulomatous lymphadenitis consistent with disseminated cocciodiomycosis. Conclusions This case report describes the first reported “incidental” pericardial effusion in a haemodynamically unstable patient sustaining a thoracoabdominal stab wound discovered on a positive ultrasound study. Emergent operative exploration and subsequent workup determined the pericardial fluid to be of infectious origin, rather than traumatic. With the incidence of cocciodiomycosis within endemic geographic regions significantly rising, coccidioidal pericarditis may become an increasingly relevant cause of fluid detected on noninvasive pericardial examination.
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Affiliation(s)
- Seth I Felder
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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11
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Ajithdoss DK, Trainor KE, Snyder KD, Bridges CH, Langohr IM, Kiupel M, Porter BF. Coccidioidomycosis presenting as a heart base mass in two dogs. J Comp Pathol 2011; 145:132-7. [PMID: 21334001 DOI: 10.1016/j.jcpa.2010.12.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 10/18/2010] [Accepted: 12/22/2010] [Indexed: 11/12/2022]
Abstract
Two atypical cases of canine coccidioidomycosis presenting as heart base masses are described. An echocardiogram performed in one of the two dogs revealed a large mass at the base of the heart and a computed tomography scan showed that the mass compressed the bronchi, left atrium, aorta and pulmonary arteries. A firm, white or pale yellow mass was found at the base of the heart at necropsy examination in both cases. Microscopical examination of the masses revealed severe, chronic, locally extensive granulomatous or pyogranulomatous inflammation with intralesional spherules consistent with Coccidioides spp. The diagnosis was further confirmed by immunohistochemistry and in-situ hybridization. Coccidioides spp. have been reported to cause pericarditis in dogs, but this is the first description of coccidioidomycosis mimicking a heart-based tumour in dogs.
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Affiliation(s)
- D K Ajithdoss
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA.
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12
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Abstract
This report describes a 25-year-old human immunodeficiency virus- seropositive patient who initially presented with clinical features of a tuboovarian abscess. After a poor response to antibiotic therapy, laparotomy and excision of a right-sided, unilocular, pseudocystic ovarian mass measuring 140 x 80 x 60 mm were undertaken. Mucoid gelatinous material, with a glistening appearance and slimy consistency, coated the inner surface of the thick wall. The cyst contained clear, viscid fluid with a similar slimy consistency. Although the macroscopic diagnosis was that of an ovarian mucinous cystadenocarcinoma, histopathologic assessment confirmed a well-circumscribed pseudocystic cryptococcoma with a wall of granulation and fibrous tissue and compressed ovarian stroma. The inner surface was covered by large, paucireactive, extracellular "yeast lakes" of carminophilous Cryptococcus neoformans yeasts of varying shape and size. To the best of our knowledge, this is the first documentation of ovarian cryptococcosis in the English language literature. Despite their rarity in the female genital tract, fungal infections must be considered in the differential diagnosis of patients presenting with pelvic pain of obscure origin and a pelvic mass that is refractory to antibiotic therapy.
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Crum-Cianflone NF, Truett AA, Teneza-Mora N, Maves RC, Chun HM, Bavaro MF, Hale BR. Unusual presentations of coccidioidomycosis: a case series and review of the literature. Medicine (Baltimore) 2006; 85:263-277. [PMID: 16974211 DOI: 10.1097/01.md.0000236953.95213.ac] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Coccidioidomycosis is an emerging fungal infection of the southwestern United States. Although Coccidioides species infections are usually asymptomatic or result in a mild, flu-like illness, disseminated disease may occur in 1% of cases. While extrapulmonary disease usually involves the skin, central nervous system, bones, or joints, coccidioidomycosis is a great imitator, with the ability to infect any tissue or organ. Cases may be diagnosed outside of endemic areas, hence providers worldwide should be aware of the broad range of manifestations of coccidioidomycosis. We present a case series of unusual presentations of coccidioidomycosis including serous cavity infections with cases of pericarditis, empyema, and peritonitis, as well as unusual abscesses involving the retropharyngeal space and gluteal musculature. We provide a complete review of the literature and summarize the clinical presentations, diagnoses, and treatments of these rare forms of disseminated coccidioidomycosis.
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Affiliation(s)
- Nancy F Crum-Cianflone
- From Department of Infectious Diseases, Naval Medical Center San Diego, San Diego, California
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14
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Yazici G, Dilek UT, Karabacak T, Ertunc D, Korkmaz M, Dilek S. Adnexal fascioliasis masquerading as ovarian cancer. Gynecol Oncol 2005; 99:236-8. [PMID: 16051339 DOI: 10.1016/j.ygyno.2005.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Revised: 05/10/2005] [Accepted: 06/01/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND Preoperative diagnosis of ovarian cancer is still problematic as multiple disease processes may present with pelvic mass. Fascioliasis is a parasitic disease producing unique clinical manifestations. CASE REPORT A 49-year-old female patient admitted to our hospital with the complaint of occasional abdominal pain. Pelvic examination revealed a right adnexal mass. Serum CA-125 level was elevated. Explorative laparotomy was performed with the initial diagnosis of ovarian tumor. Final diagnosis was adnexal fascioliasis. CONCLUSION In the setting of a newly diagnosed pelvic mass, care should be taken when interpreting an elevated CA-125 level. While ovarian cancer is high on the list of differential diagnoses, atypical clinical presentation of fasciola may give rise to a misdiagnosis of malignancy.
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Affiliation(s)
- Gurkan Yazici
- Department of Obstetrics and Gynecology, School of Medicine, Mersin University, Liparis Plaza, Orkide Blok, Kat: 5, Daire:12, 33170 Mezitli, Mersin, Turkey.
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