Coccidioidomycosis and the skin: a comprehensive review

Abstract

Coccidioidomycosis is a highly prevalent disease in the Western hemisphere. It is considered one of the most virulent primary fungal infections. Coccidioides species live in arid and semi-arid regions, causing mainly pulmonary infection through inhalation of arthroconidia although many other organs can be affected. Primary inoculation is rare. Since the first case of coccidioidomycosis was reported in 1892, the skin has been identified as an important target of this disease. Knowledge of cutaneous clinical forms of this infection is important and very useful for establishing prompt diagnosis and treatment. The purpose of this article is to provide a review of this infection, emphasizing its cutaneous manifestations, diagnostic methods and current treatment.

Cutaneous effects associated with fluconazole in patients treated for coccidioidomycosis

“…Various nonspecific coccidioidal cutaneous conditions often occur early in the course of coccidioidomycosis, including erythema nodosum, erythema multiforme, toxic erythema, and other eruptions. Such conditions typically resolve early, and none existed for our patients at the time of survey administration. To control for infection and environmental factors that could influence the findings, we also surveyed coccidioidomycosis patients not taking fluconazole.…”

“…Of concern, lower doses of fluconazole can theoretically place a patient at risk for treatment failure. Therefore, when cutaneous symptoms are intolerable for a patient, fluconazole can be discontinued and a different antifungal agent tried …”

A Case of Osteomyelitis of the toe caused by Coccidioidomycosis in a 17 year-old with Diabetes Insipidus

“…However, it seemed unlikely as primary cutaneous infection is extremely rare, with about 25 cases previously reported in literature since 1926 [19]. Primary cutaneous infection results from direct traumatic inoculation of the organism into the skin by an external source and typically manifests as a painless, indurated nodule with ulceration [19].…”

Follicular papules and pustules in a patient with pulmonary symptoms

“…Reactive lesions are more common and represent an immune response to fungal antigens. Reactive skin lesions include erythema nodosum, erythema multiforme, morbilliform eruptions and Sweet syndrome, among others . By contrast, organism‐specific lesions represent locally invasive skin infections, and develop as a result of direct inoculation or disseminated pulmonary disease.…”