Coccidioidomycosis in pregnancy: Case report and literature review of associated placental lesions

Abstract

Background: Coccidioidomycosis is an endemic fungal infection found most commonly in the Southwestern United States, Northwestern Mexico, and parts of Central and South America. Although infection is relatively uncommon during pregnancy, it is imperative to have an index of suspicion in order to diagnose and begin timely treatment to prevent dissemination and dire consequences.

Case report: A 33-year-old Hispanic female was evaluated after she was involved in an automobile accident. Radiographic evaluation showed a 3.2 × 3.2 cm cavitary thick-walled lesion. A biopsy was negative for malignancy. Evaluation was positive for coccidioidomycosis by complement fixation reaction. Four months later, the patient presented 7 weeks into a pregnancy with massive hemoptysis. Bronchoscopy revealed bleeding from the right upper lobe and emergency embolization was performed. The patient had a spontaneous abortion 9 days after admission. The right upper and middle lobes of the lung were resected due to continuous bleeding. A subsequent pregnancy was un-eventful. Coccidioidomycosis titers remained negative throughout the second pregnancy.

Discussion: This case demonstrates the potential for severe pulmonary coccidioidomycosis and vascular strain of pregnancy-associated vascular expansion in the first trimester of pregnancy and the possibility of a favorable pregnancy outcome in subsequent pregnancies after appropriate treatment. The route of feto-maternal transmission and placental lesions in coccidioidomycosis are discussed.

Keywords: Coccidioidomycosis; Placental lesions; Pregnancy.

Fig. 1

A. Melting curve for β-actin (pink color, melting temperature 87.5 °C) and Coccidioides spp. (blue color, melting temperature 85.5 °C.) in the control DNA samples, placental samples (placenta, attached to placenta umbilical cord, fetal membranes) and soil samples. Note: placental samples do not show specific amplification. B. Standard curve for quantifying Coccidiosis spp. that was created by using 4 standards with the following dilutions: 60,000 copies/rxn, 6000 copies/rxn, 600 copies/rxn, and 60 copies/rxn.

Fig. 2

(A) Microphotographs of the placenta, demonstrating villous calcification shown at 100 × magnification, (B) increased number of syncytial knots shown at 100 × magnification, (C) edematous villi shown at 100 × magnification, and (D) necrosis (arrows) shown at 40 × magnification.