Disseminated Coccidioidomycosis with Clinically Evident Splenomegaly in an Immunocompetent Host, First Case Reported in the literature

Abstract

Coccidioidomycosis is a dimorphic fungus endemic to the southwestern United States, Central and South America. We report a case of a previously healthy person who presented with respiratory failure and disseminated Coccidioidomycosis who eventually had a fatal outcome. Coccidioidomycosis, or “Valley Fever” has been called the “great imitator” (1) as it can have a wide variety of clinical presentations. This case is unique as it represents the first described case of an immunocompetent host with rapidly progressing, disseminated coccidioidomycosis with clinically apparent splenomegaly and hepatomegaly.

Cross-sectional imaging findings of splenic infections: is differential diagnosis possible?

“…The disease is usually acquired from dust exposure from the soil containing the infectious spores. HIV infection and other immunosuppressive conditions may predispose patients to disseminated disease [66]. Splenic involvement is rare and was reported in the disseminated form of the disease.…”

“…In the presence of a history of primary malignancy, metastases should also be strongly considered. PET/CT with 18-fluorodeoxyglucose (FDG) can help distinguish metastases from benign lesions, especially in patients with a history of malignancy [66]. Close imaging follow-up to determine the temporal evolution of lesion size or histopathological examination may be considered depending on the patient characteristics [76].…”