Coccidioidomycosis and the skin: a comprehensive review

Abstract

Coccidioidomycosis is a highly prevalent disease in the Western hemisphere. It is considered one of the most virulent primary fungal infections. Coccidioides species live in arid and semi-arid regions, causing mainly pulmonary infection through inhalation of arthroconidia although many other organs can be affected. Primary inoculation is rare. Since the first case of coccidioidomycosis was reported in 1892, the skin has been identified as an important target of this disease. Knowledge of cutaneous clinical forms of this infection is important and very useful for establishing prompt diagnosis and treatment. The purpose of this article is to provide a review of this infection, emphasizing its cutaneous manifestations, diagnostic methods and current treatment.

Figure 1

Erythema nodosum, considered the most frequent reactive manifestation and commonly involving the lower extremities

Figure 2

Histopathologic image of erythema nodosum in a patient with coccidioidomycosis. No organisms were found within the specimen

Figure 3

Erythema multiforme: another common cutaneous manifestation of coccidioidomycosis, characterized by target-like lesions

Figure 4

Disseminated coccidioidomycosis presenting as an erythematous, crusted plaque in the upper extremity

Figure 7

Disseminated coccidioidomycosis presenting as an erythemato-squamous plaque on the upper chest

Figures 8

Biopsy specimen showing a Coccidioides spherule

Figures 9

Primary coccidioidomycosis presenting as lesions in a typical sporothricoid pattern

Figures 10

Coccidioidomycosis culture: white, cottony mold

Figures 11

Direct microscopy study of coccidioidomycosis

Figures 12

Gomori-Grocott stain

Figure 5

Verrucous plaques are also a common manifestation of disseminated coccidioidomycosis

Figure 6

In this patient, disseminated coccidioidomycosis presented as an ulcerated nodule on the face