Disseminated Coccidioidomycosis Presenting as Carcinomatosis Peritonei and Intestinal Coccidioidomycosis in a Patient with HIV

Abstract

Coccidioidomycosis (CM) is a fungal infection endemic in southwestern regions of the United States, northwestern regions of Mexico, and some areas of Brazil and Argentina. Clinical presentation varies depending on the extent of the infection and the immune status of the host. The most common presentation ranges from flu-like symptoms to self-limiting pneumonia. Extrapulmonary presentations are uncommon and may involve the meninges, skin, and bone. Gastrointestinal and peritoneal involvement is extremely rare. Here we report a case of disseminated CM presenting as carcinomatosis peritonei as an AIDS-defining illness in a young male.

Keywords: Acquired immunodeficiency syndrome; Carcinomatosis peritonei; Coccidioidomycosis.

Fig. 1

CT of the abdomen and pelvis of the patient on admission. The abdominal image (a) shows mesenteric lymphadenopathy. The pelvic image (b) shows terminal ileum thickening suggestive of a possible mass. The CT report suggested possible neoplasm. However, after further studies, we know these changes occurred due to coccidioidomycosis infection.

Fig. 2

Endoscopic images of the abnormal mucosa noted in our patient. a Erythematous swollen ileocecal valve, denoted by an asterisk. b Inflammatory nodular mucosa in the upper half of terminal ileum, denoted by an arrow. This contrasts with the normal mucosa noted in the lower half of the same image.

Fig. 3

Histology from the ileal biopsy. It reveals 3 coccidioidomycosis spherules, denoted by arrows. The spherule on the right-hand side is actively releasing endospores.