TY - JOUR
T1 - Pandora’s box
T2 - Disseminated coccidioidomycosis associated with self-medication with an unregulated potent corticosteroid acquired in Mexico
AU - Jose Coba, Alejandro
AU - Sallee, Patricia K.
AU - Dixon, Danielle O.
AU - Alkhateb, Rahaf
AU - Anstead, Gregory M.
N1 - Funding Information:
Funding: This research was funded by the Department of Veterans Affairs and the University of Texas Health San Antonio.
Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2021/12
Y1 - 2021/12
N2 - Coccidioidomycosis (CM), caused by the dimorphic fungi Coccidioides immitis and C. posadasii, typically presents as acute or chronic pulmonary disease. However, disseminated disease occurs in about 1% of patients. Disseminated CM may affect multiple organ systems, including cutaneous, osteoarticular, and central nervous system sites. Here, we present a case of disseminated CM in a patient from a border city in Texas. The patient had a history of uncontrolled diabetes mellitus and was also taking an over-the-counter medication acquired in Mexico that contained a potent corticosteroid. The patient presented with seizures and was found to have a brain infarct, cavitary lung lesions, synovitis of the knee, multiple skin lesions, and chorioretinitis. The patient had a very high complement fixation titer for Coccidioides; fungal spherules were seen in a skin biopsy specimen, and Coccidioides grew in culture from a sample of synovial fluid and the skin biopsy specimen. This case illustrates the dissemination potential of Coccidioides, the danger of unregulated pharmaceu-ticals, the importance of thorough history taking, and recognizing risk factors that contribute to disseminated CM.
AB - Coccidioidomycosis (CM), caused by the dimorphic fungi Coccidioides immitis and C. posadasii, typically presents as acute or chronic pulmonary disease. However, disseminated disease occurs in about 1% of patients. Disseminated CM may affect multiple organ systems, including cutaneous, osteoarticular, and central nervous system sites. Here, we present a case of disseminated CM in a patient from a border city in Texas. The patient had a history of uncontrolled diabetes mellitus and was also taking an over-the-counter medication acquired in Mexico that contained a potent corticosteroid. The patient presented with seizures and was found to have a brain infarct, cavitary lung lesions, synovitis of the knee, multiple skin lesions, and chorioretinitis. The patient had a very high complement fixation titer for Coccidioides; fungal spherules were seen in a skin biopsy specimen, and Coccidioides grew in culture from a sample of synovial fluid and the skin biopsy specimen. This case illustrates the dissemination potential of Coccidioides, the danger of unregulated pharmaceu-ticals, the importance of thorough history taking, and recognizing risk factors that contribute to disseminated CM.
KW - Coccid-ioidal synovitis
KW - Coccidioidal chorioretinitis
KW - Corticosteroid
KW - Cutaneous coccidioidomycosis
KW - Disseminated coccidioidomycosis
KW - Pulmonary coccidioidomycosis
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U2 - 10.3390/tropicalmed6040207
DO - 10.3390/tropicalmed6040207
M3 - Article
AN - SCOPUS:85121292062
SN - 2414-6366
VL - 6
JO - Tropical Medicine and Infectious Disease
JF - Tropical Medicine and Infectious Disease
IS - 4
M1 - 207
ER -