Disseminated Coccidioidomycosis Presenting as Carcinomatosis Peritonei and Intestinal Coccidioidomycosis in a Patient with HIV

Abstract

Coccidioidomycosis (CM) is a fungal infection endemic in southwestern regions of the United States, northwestern regions of Mexico, and some areas of Brazil and Argentina. Clinical presentation varies depending on the extent of the infection and the immune status of the host. The most common presentation ranges from flu-like symptoms to self-limiting pneumonia. Extrapulmonary presentations are uncommon and may involve the meninges, skin, and bone. Gastrointestinal and peritoneal involvement is extremely rare. Here we report a case of disseminated CM presenting as carcinomatosis peritonei as an AIDS-defining illness in a young male.

Coccidioidal Peritonitis: A Review of 17 Cases

“…One case demonstrated small bowel obstruction. Imaging may demonstrate ascites, mesenteric, or peritoneal caking thus prompting concerns of underlying malignancy, although the differential diagnosis of intra-abdominal caking should include the following: CM or other fungal diseases, tuberculosis (Tb), and carcinomatosis [ 15 ].…”

Intestinal Paracoccidioidomycosis: Case report and literature review

“…Its presentation is more frequent in patients with risk factors that favor hematogenous dissemination, among which the male gender generally stands out in the context of immunosuppression. Taking into account that the most important role in protection is played by macrophages, which are only effective if the helper lymphocytes (CD4 +) are competent [7] , pregnant women, patients with active neoplastic processes and those with immunosuppression states (acquired immunodeficiency syndrome, lymphoma or transplant recipients especially) are more susceptible to presenting disseminated disease [1] , [8] . To date no immunological derangements have been documented in our patient.…”

Disseminated Coccidioidomycosis Following Insufficient Treatment at Initial Presentation: Case Report

“…There have been previously documented cases of low-risk individuals developing DC. 3,9 Many cases reported that the progression of disease in these individuals was due to a delay in diagnosis at initial presentation. 9 Although our patient's treatment was not delayed, the duration of his treatment was inappropriate.…”

“… 2 However, in some cases, macrophages that ingest the arthroconidia enter the lymphatic system and lead to disseminated disease. 3 The severity of disease can vary from mild to life-threatening disease. 4 The organs involved in disseminated disease include the skin, bones, joints, and central nervous system.…”