Disseminated coccidioidomycosis. Unusual manifestations in a cardiac transplantation patient.
Because of the immunosuppressive therapy received by patients undergoing cardiac transplantation, disseminated infections, including disseminated fungal infections, often develop. Disseminated coccidioidomycosis developed in a 23-year-old man soon after undergoing orthotopic cardiac transplantation. Clinical manifestations included an unusual rash, severe myositis and arthropathy, a rapid downhill course, and pathologic evidence of widespread fungal invasion, including invasion of the cardiac graft. Detailed travel and geographic histories, and perhaps skin testing and antibody determinations for geographic-specific pathogens, should be part of the preoperative evaluation of all transplant candidates.
Vartivarian
S E
SE
Division of Infectious Diseases, Medical College of Virginia, Richmond.
Coudron
P E
PE
Markowitz
S M
SM
D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000628:therapy; D003047:Coccidioidomycosis / Q000209:etiology*; D016027:Heart Transplantation; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D008297:Male; D012307:Risk Factors; D014195:Travel