Disseminated peritoneal coccidioidomycosis in pregnancy following fertility treatment: A case report and literature review

Abstract

Disseminated peritoneal coccidioidomycosis in the setting of early pregnancy after fertility treatment is rare and can present as a diagnostic challenge. A 39-year-old underwent ovarian stimulation with clomiphene citrate followed by HCG trigger and intrauterine insemination. She developed persistent abdominal pain, ascites and episodes of fever in early pregnancy, and eventually underwent a diagnostic laparoscopy for worsening clinical presentation. Operative findings were notable for peritoneal studding, infracolic omentum inflammation, bowel adhesions to the abdominal wall and normal-appearing uterus and adnexa. The pathology results indicated peritoneal Coccidioides immitis infection. Hormonal changes associated with fertility treatment and immune tolerance in pregnancy may increase the risk for disseminated peritoneal coccidioidomycosis. A high index of suspicion and a multidisciplinary team are important for the diagnostic workup and treatment plan of disseminated peritoneal coccidioidomycosis.

The Known and Unknown “Knowns” of Human Susceptibility to Coccidioidomycosis

“…Testosterone increases during pregnancy, with total testosterone increasing during the first trimester and remaining elevated, while free testosterone is 2-3 fold higher during the third trimester [86,87]. Supporting a potential role for testosterone, one case report of peritoneal coccidioidomycosis occurred following fertility treatment with clomiphene citrate [88], which is documented to increase testosterone levels and, in fact, is used off-label to treat hypogonadism and low testosterone in men [89].…”