Coccidioidomycosis masquerading as malignancy.
Skeletal coccidioidomycosis is extremely rare and in the non-endemic areas, diagnosis is often delayed or missed resulting in extensive and unnecessary medical investigation for other diseases. The authors report a case of disseminated skeletal coccidioidomycosis in a previously healthy person living in a non-endemic area, who was initially thought to have a malignancy. Due to the presence of multiple expansile lytic bone lesions on x-rays and CT scan, an extensive investigation for malignancy was done. Diagnosis of coccidioidomycosis was made when H&E and Gomori's methenamine silver staining of a bone biopsy sample revealed multiple fungal spherules, which were confirmed to be Coccidioides immitis by culture and PCR. On questioning, the patient admitted to have spent 2 weeks in Arizona (an endemic area) few months ago. He was discharged home on long-term fluconazole. At 1 month clinical follow-up, a significant improvement in his lesions was noticed.
Department of Internal Medicine, Wayne State University School of Medicine, Detroit Medical Center, Detroit, Michigan, USA. narora@med.wayne.edu
Natasha Purai
NP
Arora
Vikas
V
Taneja
Carlos
C
ReyesSacin
Ravinder
R
Bhanot
Suganthini Krishnan
SK
Natesan
D000328:Adult; D001859:Bone Neoplasms / Q000175:diagnosis*; D002968:Clavicle / Q000382:microbiology / Q000473:pathology; D003045:Coccidioides; D003047:Coccidioidomycosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D010019:Osteomyelitis / Q000175:diagnosis; D011859:Radiography; D011877:Radionuclide Imaging