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Gonzalez R, Naeem F, Ozaki Y, Vijayan V. Disseminated Coccidioidomycosis in an Adolescent With Crohn's Disease. Cureus 2021; 13:e19980. [PMID: 34984138 PMCID: PMC8714043 DOI: 10.7759/cureus.19980] [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: 11/28/2021] [Indexed: 12/02/2022] Open
Abstract
Coccidioidomycosis is a systemic mycosis caused by Coccidioides immitis/posadasii. This dimorphic fungus is endemic to the Southwestern United States, particularly in California and Arizona. Most infections are asymptomatic or mild, but around 5% of patients develop complicated pulmonary infection, and approximately 1% may progress to disseminated disease. We present the case of an adolescent male with Crohn's disease who received the integrin inhibitor, vedolizumab, and developed disseminated coccidioidomycosis. This case underscores the importance of considering severe and/or disseminated coccidioidomycosis in immunosuppressed children. In our case, clinical suspicion and bronchoscopy helped confirm the diagnosis and facilitate appropriate evaluation and treatment.
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Affiliation(s)
| | - Fouzia Naeem
- Pediatric Infectious Diseases, Valley Children's Healthcare, Madera, USA
| | | | - Vini Vijayan
- Pediatrics, Valley Children's Healthcare, Madera, USA
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4
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Naeem M, Menias CO, Cail AJ, Zulfiqar M, Ballard DH, Pickhardt PJ, Kim DH, Lubner MG, Mellnick VM. Imaging Spectrum of Granulomatous Diseases of the Abdomen and Pelvis. Radiographics 2021; 41:783-801. [PMID: 33861648 DOI: 10.1148/rg.2021200172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A granuloma is a compact organization of mature macrophages that forms because of persistent antigenic stimulation. At the microscopic level, granulomas can undergo various morphologic changes, ranging from necrosis to fibrosis, which along with other specialized immune cells define the appearance of the granulomatous process. Accordingly, the imaging features of granulomatous diseases vary and can overlap with those of other diseases, such as malignancy, and lead to surgical excisions and biopsy. However, given the heterogeneity of granulomas as a disease group, it is often hard to make a diagnosis on the basis of the histopathologic features of granulomatous diseases alone owing to overlapping microscopic features. Instead, a multidisciplinary approach is often helpful. Radiologists need to be familiar with the salient clinical manifestations and imaging findings of granulomatous diseases to generate an appropriate differential diagnosis. ©RSNA, 2021.
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Affiliation(s)
- Muhammad Naeem
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - Christine O Menias
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - Austin J Cail
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - David H Ballard
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - Perry J Pickhardt
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - David H Kim
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - Meghan G Lubner
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (M.N., A.J.C., M.Z., D.H.B., V.M.M.); Division of Abdominal Imaging, Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.); and Division of Abdominal Imaging and Intervention, Department of Radiology, University of Wisconsin-Madison, Madison, Wis (P.J.P., D.H.K., M.G.L.)
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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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Piech TL, Jaffey JA, Hostnik ET, White ME. Bicavitary eosinophilic effusion in a dog with coccidioidomycosis. J Vet Intern Med 2020; 34:1582-1586. [PMID: 32447816 PMCID: PMC7379003 DOI: 10.1111/jvim.15810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 02/02/2023] Open
Abstract
This is a case of coccidioidomycosis in a dog, examined for vomiting and labored breathing. Physical examination and thoracic and abdominal imaging revealed pleural and peritoneal effusions, both of which exhibited neutrophilic inflammation with a substantial eosinophilic component. The dog had positive IgM and IgG coccidioidomycosis titers at initial evaluation. The eosinophilic component of the inflammation was attributed to coccidioidomycosis. The dog underwent approximately 6 months of fluconazole treatment, with both effusions and clinical signs improving after 6 weeks. Three months after cessation of antifungal treatment, the dog developed a mid‐diaphyseal lytic and proliferative lesion in the left radius caused by Coccidioides spp. This case illustrates the importance of consideration of coccidioidomycosis when an eosinophilic cavitary effusion is present in dogs that live in or have traveled to endemic regions.
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Affiliation(s)
- Tara L Piech
- Department of Veterinary Biomedical Sciences, College of Veterinary Medicine, Long Island University, Brookville, New York, USA
| | - Jared A Jaffey
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, USA
| | - Eric T Hostnik
- Department of Veterinary Clinical Sciences, Veterinary Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Mary E White
- Department of Pathology and Population Medicine, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, USA
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Forrester JD, Guo HH, Weiser TG. Coccidioidomycosis: Surgical Issues and Implications. Surg Infect (Larchmt) 2016; 17:645-655. [PMID: 27740893 DOI: 10.1089/sur.2016.148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coccidioidomycosis, commonly called "valley fever," "San Joaquin fever," "desert fever," or "desert rheumatism," is a multi-system illness caused by infection with Coccidioides fungi (C. immitis or C. posadasii). This organism is endemic to the desert Southwest regions of the United States and Mexico and to parts of South America. The manifestations of infection occur along a spectrum from asymptomatic to mild self-limited fever to severe disseminated disease. METHODS Review of the English-language literature. RESULTS There are five broad indications for surgical intervention in patients with coccidioidomycosis: Tissue diagnosis in patients at risk for co-existing pathology, perforation, bleeding, impingement on critical organs, and failure to resolve with medical management. As part of a multidisciplinary team, surgeons may be responsible for the care of infected patients, particularly those with severe disease. CONCLUSION This review discusses the history, microbiology, epidemiology, pathology, diagnosis, and treatment of coccidioidomycosis, focusing on situations that may be encountered by surgeons.
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Affiliation(s)
| | - Haiwei Henry Guo
- 2 Department of Radiology, Stanford University , Stanford, California
| | - Thomas G Weiser
- 1 Department of Surgery, Stanford University , Stanford, California
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Satyanarayan A, Klotz S, Han L, Sobonya R, Zangeneh TT. Coccidioidomycosis of the genitourinary tract: a case report and discussion. Urology 2014; 84:e30-1. [PMID: 25306476 DOI: 10.1016/j.urology.2014.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/16/2014] [Accepted: 08/05/2014] [Indexed: 11/25/2022]
Abstract
Coccidioides species (Coccidioides immitis and Coccidioides posadasii) are dimorphic fungi endemic to the Southwestern United States. Initial infection ranges from asymptomatic to mild upper respiratory tract symptoms and may disseminate to other organs including the genitourinary tract. Genitourinary complaints may be the initial presenting signs and symptoms among a minority of patients. We report a case of genitourinary coccidioidomycosis and discussion of genitourinary disease with coccidioidomycosis.
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Affiliation(s)
| | - Stephen Klotz
- Department of Medicine, Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, AZ
| | - Lucy Han
- University of Arizona College of Medicine, Tucson, AZ
| | - Richard Sobonya
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ
| | - Tirdad T Zangeneh
- Department of Medicine, Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, AZ.
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