title: The head of the pancreas: another unusual site of coccidioidomycosis.
abstract: BACKGROUND
  The lung is the most common site of coccidioidomycosis, with extrapulmonary sites of infection being described rarely. To date, the pancreas has not been reported as an isolated site of coccidioidomycosis.
  
  
  METHODS
  Case report and literature review.
  
  
  METHODS
  Computed tomography (CT)-guided biopsy and gram staining of the pancreatic lesion of an immunocompetent patient without known risk factors revealed coccidioidomycosis of the head of the pancreas without malignant neoplasm or atypia. Serologic tests yielded positive titers for antibodies to Coccidioides lmmitis. The patient responded to treatment with fluconazole, as evidenced by regression of her pancreatic lesion by CT and negative serologic test results for Coccidioides upon completion of treatment.
  
  
  CONCLUSIONS
  Solid masses in the head of the pancreas encountered in surgical practice are challenging in terms of both surgical technique and diagnosis. Although malignant disease remains a high possibility in the differential diagnosis of such masses, and must always be considered until proved to be absent, non-malignant etiologies should also be considered. In a number of patients with benign lesions of the pancreatic head, unnecessary surgical exploration and resection is avoidable. Although they are rare, several fungal infections of the pancreas have been reported in the literature. The unusual case of coccidioidomycosis of the pancreatic head presented here adds to the list of uncommon causes of pancreatic lesions. Surgeons and physicians managing patients in areas in which coccidioidomycosis is endemic should be aware of this rare entity.
authors.affiliation: Department of Surgery, San Joaquin General Hospital , French Camp, California.
authors.forename: Sam
authors.initials: S
authors.lastname: Zaid
authors.forename: Ahmed
authors.initials: A
authors.lastname: Mahmoud
authors.forename: Maged
authors.initials: M
authors.lastname: Barry
authors.forename: Robert
authors.initials: R
authors.lastname: Yavrouian
mesh_terms: D000908:Antibodies, Fungal / Q000097:blood; D000935:Antifungal Agents / Q000627:therapeutic use; D001706:Biopsy; D003045:Coccidioides / Q000302:isolation & purification*; D003047:Coccidioidomycosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006651:Histocytochemistry; D006801:Humans; D008853:Microscopy; D010179:Pancreas / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology*; D010195:Pancreatitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D049268:Positron-Emission Tomography; D011860:Radiography, Abdominal; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D000908:Antibodies, Fungal; D000935:Antifungal Agents; D015725:Fluconazole