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Case Reports
. 2021 Apr 12;14(4):e227217.
doi: 10.1136/bcr-2018-227217.

Disseminated coccidioidomycosis in a patient who is immunocompromised in the setting of immune reconstitution inflammatory syndrome

Hamid Yaqoob  1 , Muhammad Mohsin Munawar  1 , Omer Salih  1 , Anand Deonarine  2
Affiliations
Case Reports

Disseminated coccidioidomycosis in a patient who is immunocompromised in the setting of immune reconstitution inflammatory syndrome

Hamid Yaqoob et al. BMJ Case Rep. .

Abstract

Coccidioidomycosis is a systemic fungal infection first described in 1892. More than 95% of annual cases occur in Arizona and California. It is an opportunistic infection (OI) transmitted via inhalation of airborne spores (arthroconidia) and rarely via percutaneous inoculation into a tissue or solid organ transplantation in patients who are immunocompromised and with HIV. With the advent of antiretroviral therapy (ART), the incidence of OIs has markedly reduced; however, OIs continue to occur, particularly in patients who present late for medical care or delay ART initiation. In rare cases, immunodeficient individuals may experience a paradoxical worsening or unmasking of OI symptoms, known as the immune reconstitution inflammatory syndrome (IRIS). We present a case of a 31-year-old man with disseminated coccidioidomycosis affecting the spleen, lymph nodes, lungs, bone marrow, and adrenals who developed IRIS after the initiation of ART.

Keywords: HIV / AIDS; immunology; infections.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Chest X-ray showing large right lower lobe infiltrate.
Figure 2
Figure 2
CT of the chest revealing pericardial effusion, and right-sided infiltrates.
Figure 3
Figure 3
CT of the abdomen revealing periaortic lymphadenopathy and hepatosplenomegaly.
Figure 4
Figure 4
Repeat X-ray showing resolution of infiltrates.
See this image and copyright information in PMC

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