Coccidioidomycosis with Diffuse Miliary Pneumonia

Sotello, David; Rivas, Marcella; Fuller, Audra; Mahmood, Tashfeen; Orellana-Barrios, Menfil; Nugent, Kenneth

doi:10.1080/08998280.2016.11929351

Cited by 5 publications

(6 citation statements)

References 11 publications

(24 reference statements)

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“…Serologic testing for IgM and IgG antibodies with CF is regularly used in order to diagnose infections due to Coccidioides and help guide therapy. 4,18 One small study, analyzing patients with HIV and disseminated C immitis , showed consistently negative CF titers in 25% of patients. 18 Another retrospective study documents initial negative serology in 17% of HIV patients with confirmed Coccidioides .…”

Section: Discussionmentioning

confidence: 99%

“…Diffuse pulmonary processes are associated with unfavorable prognoses and are most commonly identified in advanced cases of immunosuppression, like the CD4 count <20 cells/µL in our patient. 4,19,21 Dyspnea and fever are the most common symptoms and the reticulonodular pattern revealed by imaging is generally attributed to hematogenous spread in patients with fungemia. 22 Additional modalities that aid in diagnosis include histopathology showing spherules and fungal cultures.…”

Section: Discussionmentioning

confidence: 99%

“…3 Coccidioidomycosis is a relatively common fungal infection that may lead to diffuse reticulonodular pneumonia, fungemia, and disseminated diseases in immune-compromised hosts residing in endemic locations. 4 Immunosuppressed patients are at increased risk of disseminated coccidioidomycosis due to impaired cellular immune function. 5,6 The regular use of ART has been critically important in preventing OI, with one study reporting a decrease in rate of OI in HIV patients from 140 per 1000 person/years in 1995 to <20 per recent illnesses or other symptoms prior to the onset of headaches.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Concomitant Central Nervous System Toxoplasmosis and Seronegative Disseminated Coccidioidomycosis in a Newly Diagnosed Acquired Immune Deficiency Syndrome Patient

Valdez

Moosavi

Heidari

2019

Journal of Investigative Medicine High Impact Case Reports

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Opportunistic infections (OIs) are a significant cause of morbidity and mortality in immunosuppressed patients and may be due to bacteria, virus, protozoa, or fungi. Toxoplasmosis is a common cause of central nervous system infection in human immunodeficiency virus (HIV) patients. Coccidioidomycosis is a relatively common fungal infection that may lead to disseminated disease and fungemia in immune-compromised hosts living in endemic regions. This single-patient case report documents the presentation, diagnosis, management, and outcome of concomitant central nervous system toxoplasmosis and diffuse miliary pneumonia with fungemia due to disseminated seronegative Coccidioides immitis in a 33-year-old male patient recently diagnosed with chronic advanced HIV. Impaired cellular immune function, such as defects in the IL-12/IFN-γ pathway or T-helper IL-17-mediated response, is associated with increased severity of coccidioidomycosis. Fungemia and acute respiratory distress syndrome are both associated with very high mortality in coccidioidomycosis. In HIV hosts, negative Coccidioides serology can be seen in up to 25% of cases and therefore other diagnostic modalities should be initiated promptly and simultaneously. This case demonstrates simultaneous OI in the setting of advanced acquired immune deficiency syndrome and emphasizes the need for early diagnosis of HIV and OI in order to ensure prompt initiation of antiretroviral therapy, prophylactic, and therapeutic medications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Concomitant Central Nervous System Toxoplasmosis and Seronegative Disseminated Coccidioidomycosis in a Newly Diagnosed Acquired Immune Deficiency Syndrome Patient

Valdez

Moosavi

Heidari

2019

Journal of Investigative Medicine High Impact Case Reports

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“…Miliary tuberculosis is commonly associated with miliary pneumonia. Cases of miliary Nocardia , Mycoplasma , Blastomyces [ 7 , 8 ], Coccidioides [ 9 ], Cryptococcus [ 10 ], and Pneumocystis jirovecii [ 11 ] have been reported.…”

Section: Discussionmentioning

confidence: 99%

Miliary Histoplasmosis in a Patient with Rheumatoid Arthritis

Lum

Abidi

McCollister

et al. 2018

Case Reports in Medicine

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Miliary histoplasmosis is a rare presentation that may mimic miliary tuberculosis. We report a case of miliary histoplasmosis in a 52-year-old male who was being treated with hydroxychloroquine, methotrexate, and sulfasalazine for his rheumatoid arthritis and presented to the emergency department with shortness of breath and fevers. Computed tomography (CT) chest revealed miliary pulmonary nodules. Urine Histoplasma antigen and serum Histoplasma antigen were negative; however, Coccidioides immitis complement immunofixation assay and Coccidioides IgM were positive. The patient was initiated on treatment for pulmonary coccidioidomycosis and immunosuppression was held. However, a few days later, Histoplasma capsulatum was isolated from cultures from bronchoscopy. This case highlights the difficulty in diagnosing histoplasmosis in immunocompromised patients and the importance of having a broad differential diagnosis for miliary pulmonary nodules. Tissue culture and histopathology remain the gold standard for the diagnosis of histoplasmosis. Further research needs to be conducted to determine the optimal duration of histoplasmosis treatment in immunocompromised patients.

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“…Coccidioidomycosis is an endemic fungal infection in the Southwestern regions of the United States caused by dimorphic fungi Coccidioides immitis or Coccidioides posadasii , with C. immitis being more prevalent in California’s Central Valley. Individuals living in endemic areas with diabetes, HIV, on chemotherapy or other immunosuppressive medications, or pregnant in the third trimester are all at risk of disseminated disease [ 1 ].…”

mentioning

confidence: 99%