title: Fatal Cokeromyces recurvatus pneumonia: report of a case highlighting the potential for histopathologic misdiagnosis as coccidioides.
abstract: Cokeromyces recurvatus is a dimorphic zygomycete with histologic morphology similar to Coccidioides immitis. A 66-year-old man who was status-post bone marrow transplantation for chronic myelogenous leukemia was hospitalized with new onset rash, nausea, and vomiting and subsequently expired. A sputum culture collected on the day of death revealed heavy growth of C. recurvatus 6 days after collection. At autopsy, microscopic examination of the lungs revealed numerous thick-walled, nonbudding spherules ranging in size from 40 to 80 µm. Initial immunohistochemical staining of the formalin-fixed lung tissue was positive for Coccidioides. Additional immunoperoxidase staining revealed the organisms were consistent with a zygomycete fungus, compatible with C. recurvatus infection. Polymerase chain reaction using panfungal primers was attempted on the formalin-fixed tissue but was inconclusive. This case highlights the potential for misdiagnosing Cokeromyces as Coccidioides when the diagnosis is based on histology and immunohistochemical staining.
authors.affiliation: Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota 55455, USA.
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Ryan
authors.forename: Patricia
authors.initials: P
authors.lastname: Ferrieri
authors.forename: Ralph D
authors.initials: RD
authors.lastname: Powell
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Paddock
authors.forename: Sherif R
authors.initials: SR
authors.lastname: Zaki
authors.forename: Stefan E
authors.initials: SE
authors.lastname: Pambuccian
mesh_terms: D000368:Aged; D003047:Coccidioidomycosis / Q000175:diagnosis / Q000382:microbiology / Q000473:pathology; D003951:Diagnostic Errors; D017809:Fatal Outcome; D006801:Humans; D008168:Lung / Q000382:microbiology* / Q000473:pathology; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D008297:Male; D009090:Mucorales / Q000302:isolation & purification*; D011014:Pneumonia / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology