All That Coughs Is Not COVID-19: A Delayed Diagnosis of Disseminated Coccidioidomycosis Following Severe Acute Respiratory Syndrome Coronavirus 2 Infection

Abstract

Coccidioides immitis (and C. posadasii) are endemic fungi of the southwestern United States and northern Mexico. Uncomplicated, symptomatic Coccidioides infection most commonly causes a self-limited pneumonia; however, immunocompromised patients can manifest severe pneumonia with an additional risk of dissemination to bone, joints, soft tissues, and in the most severe the cases, the central nervous system. In the year 2020 clinicians are challenged with a previously unseen volume of acute respiratory complaints as a result of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic. We present a patient with respiratory failure secondary to SARS-CoV-2 who experienced prolonged hypoxia and neurologic deterioration, eventually leading to a diagnosis of occult disseminated coccidiomycosis involving meningitis, miliary-pattern pneumonia, and cutaneous lesions.

Coccidioidomycosis and COVID-19 Infection. An Analysis from a Single Medical Center Within the Coccidioidal Endemic Area

“…If found, it would be prudent to initiate antifungal therapy, as recommended in the Infectious Diseases Society of America guidelines for immunocompromised patients [ 9 ]. Although we did not find that any patients in this cohort who developed extrathoracic coccidioidomycosis in association with COVID-19, two case reports have reported this occurrence [ 6 , 7 ]. In addition, other case reports noted that coccidioidomycosis was not initially recognized during COVID-19 [ 10 , 11 ].…”

Fulminant Superimposed Covid-19 Pneumonia on Coccidioidomycosis Disseminated Infection

“…Our patient originates from central Mexico and worked in an area endemic to coccidioidomycosis in the United States, which also suffered from high infectivity of COVID-19 at the time of co-infection [10]. Of the seven known cases of COVID-19 associated with Coccidioides immitis, our case was unique in that rapid and fulminant decline happened within days of co-infection [2][3][4][5][6][7][8]. This is important because early detection may be crucial to survival.…”

“…The most common presentation requiring hospitalization is respiratory distress [1]. Co-infection with fungal pathogens appears to be uncommon with only seven other cases regarding coccidioides association appearing in the literature, but only this case reports rapid and fulminant decline [2][3][4][5][6][7][8].…”

Update on the Epidemiology, Diagnosis, and Treatment of Coccidioidomycosis

“…Several reports described a co-infection of Coccidioides spp. and severe acute respiratory syndrome novel coronavirus (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19) [ 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 ]. Common risk factors include older age, diabetes, immunosuppression, African American or Latino heritage, and smoking [ 91 ].…”