title: Peritoneal and genital coccidioidomycosis in an otherwise healthy Danish female: a case report.
abstract: Coccidioidomycosis is a fungal infection that usually presents as a primary lung infection. The fungus is endemic to the Southwest United States of America, northern Mexico and parts of Central and South America the infection is rare outside these areas. However, some patients develop disseminated infection that can lie dormant for several years and can present itself in travelers. We report the first case of extra pulmonary Coccidioidomycosis in a non-immunocompromised individual in Denmark.
  
  
  
  A 32 year old Danish woman presented at the Emergency department with abdominal pain. Computed tomography scan and ultrasound examination of the pelvis raised suspicion of salpingitis. A laparoscopy exposed a necrotic salpinx and several small white elements that resembled peritoneal carcinomatosis. Histological workup however determined that she suffered from disseminated coccidioidomycosis. The patient had lived 2 years in Las Vegas, in the United States of America, 7 years prior and had no memory of lung infection at the time.
  
  
  
  Disseminated coccidioidomycosis is rare in non-immunocompromised individuals. The patient in this case underwent several rounds of in vitro fertilization treatment in the years before admittance. We suspect that the hormonal treatment in combination with low-dose prednisolone may have triggered reemergence of the disease and present literature that support this.
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark. Ole.imcc@gmail.com.
authors.forename: Ole
authors.identifier: 0000-0003-0598-0952
authors.initials: O
authors.lastname: Bæk
authors.affiliation: Department of Microbiology and Infection Control, Statens Serum Institut, Unit of Mycology, Copenhagen, Denmark.
authors.forename: Karen
authors.initials: K
authors.lastname: Astvad
authors.affiliation: Department of Pathology, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Reza
authors.initials: R
authors.lastname: Serizawa
authors.affiliation: MiraVista Diagnostics, Indianapolis, IN, USA.
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Wheat
authors.affiliation: Department of Gynecology, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Pia T
authors.initials: PT
authors.lastname: Brenøe
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Ann-Brit E
authors.initials: AE
authors.lastname: Hansen
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology; D000328:Adult; D003047:Coccidioidomycosis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003718:Denmark; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008172:Lung Diseases, Fungal / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D010532:Peritoneal Diseases / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014195:Travel
keywords: Case report; Coccidioidomycosis; Disseminated; Fungus; Traveller