title: The coccidioidomycosis conundrum: a rare parotid mass.
abstract: A man, age 62 years, presented to the clinic with a 2-week history of increased nontender, nonerythematous, indurated right-sided parotid swelling. A 4 × 6-cm firm, well-circumscribed mass was palpated in the right parotid gland. A fine-needle aspiration biopsy was performed on the parotid mass with aspiration of 0.5 cc of purulent fluid with some blood. Cultures from the aspirate revealed Coccidioides immitis confirmed by DNA probe. Pathology slides revealed fungal spores. The patient was treated with 800 mg of fluconazole every day for 3 months with resolution of the parotid swelling. However, persistent cervical adenopathy remains.Although this is a rare case of acute parotid swelling, Coccidioides immitis should be considered in the differential diagnosis of parotid masses in a patient with previous coccidioidomycosis. There may be a potential for an increase in frequency and variety of atypical extrapulmonary manifestations of coccidioidomycosis that parallels the increase in coccidioidomycotic pulmonary infections. Long-term antifungal therapy appears essential for control.
authors.affiliation: Head and Neck Surgeon at the Oakland Medical Center in CA. christopher.g.tang@kp.org.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Tang
authors.affiliation: Third-year Medical Student at University of California, San Diego School of Medicine in La Jolla. ba.nuyen@gmail.com.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Nuyen
authors.affiliation: Chief of Pathology at the Oakland Medical Center in CA. balaram.puligandla@kp.org.
authors.forename: Balaram
authors.initials: B
authors.lastname: Puligandla
authors.affiliation: Head and Neck Surgeon at the Oakland Medical Center in CA. barry.rasgon@kp.org.
authors.forename: Barry
authors.initials: B
authors.lastname: Rasgon
mesh_terms: D044963:Biopsy, Fine-Needle; D003045:Coccidioides; D003047:Coccidioidomycosis / Q000175:diagnosis* / Q000382:microbiology; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000382:microbiology* / Q000473:pathology; D010306:Parotid Gland / Q000382:microbiology* / Q000473:pathology