title: Cold subcutaneous abscesses as the first manifestation of disseminated coccidioidomycosis in an immunocompromised host.
abstract: Coccidioidomycosis is an endemic fungal infection in the southwestern USA and northern Mexico. It is caused by Coccidioides immitis and C. posadasii. This infection occurs due to the inhalation of airborne arthroconidia, causing a mild pulmonary infection, but most cases are asymptomatic. Disseminated coccidioidomycosis (DC) is a rare entity occurring in less than 1% of all cases, usually in immunocompromised patients, and it carries high risks of morbidity and mortality. The skin is one of the most frequently affected organs and in some cases cutaneous lesions may be the first or only sign of infection. A wide spectrum of clinical lesions may develop, including cold abscess. In immunocompromised hosts, DC represents a diagnostic and therapeutic challenge. Treatment is based on antifungal drugs, such as amphotericin B and azoles, administered for long periods of time and under close follow up to monitor the treatment response and to detect relapse. In the following case report, we present a 35-year-old male patient with systemic lupus erythematosus under immunosuppressive therapy who presented with cold subcutaneous abscesses as the first sign of DC.
authors.affiliation: Dermatology Service, University Hospital 'Dr. José Eleuterio González', Universidad Autonóma de Nuevo León, Monterrey, México.
authors.forename: Juana Irma
authors.identifier: http://orcid.org/0000-0002-4690-0421
authors.initials: JI
authors.lastname: Garza-Chapa
authors.affiliation: Dermatology Service, University Hospital 'Dr. José Eleuterio González', Universidad Autonóma de Nuevo León, Monterrey, México.
authors.forename: Sylvia Aide
authors.initials: SA
authors.lastname: Martínez-Cabriales
authors.affiliation: Dermatology Service, University Hospital 'Dr. José Eleuterio González', Universidad Autonóma de Nuevo León, Monterrey, México.
authors.forename: Jorge
authors.initials: J
authors.lastname: Ocampo-Garza
authors.affiliation: Dermatology Service, University Hospital 'Dr. José Eleuterio González', Universidad Autonóma de Nuevo León, Monterrey, México.
authors.forename: Minerva
authors.initials: M
authors.lastname: Gómez-Flores
authors.affiliation: Dermatology Service, University Hospital 'Dr. José Eleuterio González', Universidad Autonóma de Nuevo León, Monterrey, México.
authors.forename: Jorge
authors.initials: J
authors.lastname: Ocampo-Candiani
authors.affiliation: Dermatology Service, University Hospital 'Dr. José Eleuterio González', Universidad Autonóma de Nuevo León, Monterrey, México.
authors.forename: Oliverio
authors.initials: O
authors.lastname: Welsh
mesh_terms: D000038:Abscess / Q000382:microbiology*; D000328:Adult; D003047:Coccidioidomycosis / Q000150:complications* / Q000175:diagnosis*; D003881:Dermatomycoses / Q000382:microbiology*; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy; D008297:Male
chemical_list: D007166:Immunosuppressive Agents
keywords: coccidioidomycosis; cold subcutaneous abscesses; disseminated coccidioidomycosis; immunocompromised host; systemic lupus erythematosus