Coccidioidomycosis of the male genital tract.
OBJECTIVE
Symptomatic genital tract infection is a rare manifestation of disseminated coccidioidomycosis. We characterized the clinical presentation, diagnosis, management and outcome in male patients with genitourinary coccidioidomycosis.


METHODS
We reviewed all cases of genital tract coccidioidomycosis involving testes, epididymis or prostate at our institution between 1990 and 2000, and searched the medical literature for all reports since the first reported case in 1943.


RESULTS
A total of 30 male patients with a median age of 58 years who had coccidioidomycosis of the genital tract were identified, including 6 at our institution. Four patients (13%) had a simultaneous pulmonary infection and 63% (19) had a remote history of primary pulmonary coccidioidomycosis. The most commonly involved genital tract sites were the epididymis in 18 cases, prostate in 14 and testes in 6. Patients with prostatitis presented with urinary obstruction, prostatic enlargement, tenderness and palpable nodules. Most patients with epididymal infection presented with scrotal swelling, tenderness and induration. All 30 patients (100%) had histopathological evidence of granulomatous inflammation with fungal spherules. Urine fungal cultures were positive in 19 cases (63%). A total of 12 patients received combined medical and surgical treatment, and 18 underwent surgical excision only. Most immunocompetent patients with isolated genital coccidioidomycosis did well with surgical resection alone. Six deaths occurred in patients with multifocal, extragenital, disseminated disease.


CONCLUSIONS
Male genitourinary coccidioidomycosis is rare but it should be considered in the differential diagnosis of patients with exposure to the endemic area who present with prostatitis or epididymitis.
Sohail
Muhammad R
MR
Division of Infectious Diseases (MRS), Mayo Clinic, Rochester, Minnesota, USA.
Andrews
Paul E
PE
Blair
Janis E
JE
D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D003045:Coccidioides; D003047:Coccidioidomycosis / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D003937:Diagnosis, Differential; D015725:Fluconazole / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D008297:Male; D052801:Male Urogenital Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D014566:Urogenital System / Q000473:pathology
D000935:Antifungal Agents; D015725:Fluconazole