Coccidioides immitis Cervical Lymphadenitis Complicated by Esophageal Fistula.
Coccidioidomycosis (valley fever) is caused by the dimorphic fungi Coccidioides immitis or Coccidioides posadasii. Most infections are asymptomatic or result in self-limited pneumonia; extrapulmonary dissemination via either hematogenous or lymphatic spread is rare. Here, we present a case of cervical C. immitis lymphadenitis that resulted in fistula formation to the esophagus via mediastinal extension. This case highlights a very unusual extrapulmonary manifestation of coccidioidomycosis, the difficulty in diagnosing coccidioidal infection when it is not suspected, and the importance of obtaining a thorough exposure history to assist with diagnosis.
Department of Internal Medicine, Oregon Health and Science University, Portland, OR 97239, USA.
Michael
0000-0002-4103-2004
M
Loudin
Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR 97239, USA.
Daniel R
0000-0002-3296-4926
DR
Clayburgh
Department of Internal Medicine, Oregon Health and Science University, Portland, OR 97239, USA; Division of Infectious Diseases, Oregon Health and Science University, Portland, OR 97239, USA.
Morgan
0000-0002-1214-9609
M
Hakki