Pandora’s box: Disseminated coccidioidomycosis associated with self-medication with an unregulated potent corticosteroid acquired in Mexico

Alejandro Jose Coba, Patricia K. Sallee, Danielle O. Dixon, Rahaf Alkhateb, Gregory M. Anstead

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

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.

Original languageEnglish (US)
Article number207
JournalTropical Medicine and Infectious Disease
Volume6
Issue number4
DOIs
StatePublished - Dec 2021

Keywords

  • Coccid-ioidal synovitis
  • Coccidioidal chorioretinitis
  • Corticosteroid
  • Cutaneous coccidioidomycosis
  • Disseminated coccidioidomycosis
  • Pulmonary coccidioidomycosis

ASJC Scopus subject areas

  • General Immunology and Microbiology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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