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. 2020 May 20;7(8):001659.
doi: 10.12890/2020_001659. eCollection 2020.

Disseminated Coccidioidomycosis in Africa

Samuel D Yoo  1 , John K Lusiba  2 , Robert Lukande  3 , Kyungmin Shin  4
Affiliations

Disseminated Coccidioidomycosis in Africa

Samuel D Yoo et al. Eur J Case Rep Intern Med. .

Abstract

Background: Coccidioidomycosis is an endemic disease in the Americas. No cases have been reported in Africa.

Patient: A 23-year-old HIV seronegative Ugandan man was referred to Mulago National Referral Hospital in Kampala, Uganda with a 10-month history of haemoptysis and difficulty breathing, and a 6-month history of localized swellings on the extremities. He had associated weight loss and drenching sweats, but no fevers. He had taken anti-tuberculosis medicine for 2 months with no improvement. He had never travelled out of Uganda. On physical examination, he had cystic swellings and ulcerated lesions on the extremities. He had tachypnoea, crackles in the chest and mild hepatomegaly. Bronchoscopic examination showed two masses occluding the right main bronchus. Bronchoscopic biopsy showed findings consistent with coccidioidomycosis. The patient improved with antifungal treatment and was discharged.

Conclusion: We report the first case of disseminated coccidioidomycosis with pulmonary and cutaneous manifestations in Africa.

Learning points: Coccidioidomycosis is an endemic disease in the Americas and may now be present in Africa.The patient had taken anti-tuberculosis medicine for 2 months with no improvement.Coccidioidomycosis should be considered in the differential diagnosis of tuberculosis.

Keywords: Coccidioidomycosis; bronchial mass; endemic disease; tuberculosis.

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Conflict of interest statement

Conflicts of Interests: The Authors declare that there are no competing interests.

Figures

Figure 1
Figure 1
Swelling on the thigh and skin ulceration near a medial malleolus
Figure 2
Figure 2
Chest x-ray (PA view) and CT images
Figure 3
Figure 3
Bronchoscopic findings before and after treatment. Note the reopening of the right lower lobe bronchus
Figure 4
Figure 4
Histological finding. Haematoxylin & eosin-stained section showing granulomatous inflammation associated with numerous multinucleated giant cells (arrows)
Figure 5
Figure 5
Histological findings. Periodic acid–Schiff (PAS)-stained section showing a multinucleated giant cell (arrow) containing an ingested single large spherule. Note the thick refractive wall
See this image and copyright information in PMC

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