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Disseminated peritoneal coccidioidomycosis

  • David B. Villafuerte EMAIL logo
Published/Copyright: October 8, 2021
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 121 Issue 12

A 37-year-old Hispanic man visiting from Northern Mexico was admitted due to intermittent, moderate, non-radiating, right upper quadrant abdominal pain for five days. On laboratory findings, complete blood count was only remarkable for eosinophils of 6.4 (reference range, 0.0–0.5). C-reactive protein, aspartate aminotransferase and alanine aminotransferase, bilirubin, alkaline phosphatase, and lipase were within normal limits. On physical examination, the patient was found to have a positive Murphy’s sign. Ultrasound demonstrated a distended and thickened gallbladder with multiple gallstones, including one at the gallbladder neck which measured 2.4 cm. Based on history, physical examination, and ultrasonographic findings, surgical consultation suspected the patient to be suffering from acute symptomatic cholelithisias. The patient was taken for laparoscopic cholecystectomy where adhesions (Image A), spherules (Image B), and free peritoneal fluid was discovered. Samples were obtained that revealed Gomori’s methenamine silver and Periodic acid-Schiff positive, ruptured cocci spherules, and occasional endospores; acid-fast bacillus negative, vimentin positive, syndecan 1 (CD138) positive, antigen Ki-67 ±15%; and cytokeratin CAM 5.2 positive mesothelial cells. A diagnosis of granulomatous inflammation consistent with Coccidioides infection was made. Infectious Disease was consulted and prophylactically started the patient on fluconazole treatment in case it could become symptomatic. Unfortunately, the patient did not follow up with primary care clinic as planned during discharge and attempts to contact him were fruitless. At this time, patient is considered lost to follow-up.Figure 1

: (A) Adhesions and (B) spherules were discovered during laparoscopic cholecystectomy.
:

(A) Adhesions and (B) spherules were discovered during laparoscopic cholecystectomy.

Coccidioidomycosis is contracted by inhaling the spores of the dimorphic fungi Coccidioides immitis or Coccidioides posadasii [1]. These fungi are found in the soil, most typically in endemic regions of Southwestern United States, Northern Mexico, and Central America [1]. Fewer than 50 cases of peritoneal Coccidioides infection have been reported worldwide, even though it is suspected to be more common [2], [3], [4]. In reported cases of symptomatic peritoneal involvement, patients present similarly to non-peritoneal symptomatic cases with low-grade fevers, cough, joint pain, headaches, and abdominal pain. However, it is suspected that over half of individuals with Coccidioidomycosis do not seek medical attention due to a subclinical presentation [5]. Similar to mild cases, it is believed that subclinical disease is self-limited [6]. A link between Coccidioidomycosis and cholelithiasis is not known or suspected. Therefore, if this patient had not been suffering from comorbid cholelithiasis, the patient’s infection may have never been uncovered.

Corresponding author: David B. Villafuerte, DO, Laredo Medical Center, Internal Medicine, 1700 E. Saunders Street, Laredo, TX 78041, USA, E-mail:

  1. Research funding: None reported.

  2. Author contributions: The author has responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: None reported.

References

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Received: 2021-07-27
Accepted: 2021-09-13
Published Online: 2021-10-08

© 2021 David B. Villafuerte, published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

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https://doi.org/10.1515/jom-2021-0193
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Articles in the same Issue

  1. Frontmatter
  2. Cardiopulmonary Medicine
  3. Brief Report
  4. C-reactive protein levels associated with COVID-19 outcomes in the United States
  5. General
  6. Clinical Practice
  7. Utilizing the Four Tenets of Osteopathic Medicine as an intersectional framework for approaching sexual orientation and gender identity disclosure as a provider
  8. Medical Education
  9. Original Article
  10. Mini-medical school programs decrease perceived barriers of pursuing medical careers among underrepresented minority high school students
  11. Neuromusculoskeletal Medicine (OMT)
  12. Review Article
  13. Efficacy of osteopathic manipulative treatment in patients with Parkinson’s disease: a narrative review
  14. Public Health and Primary Care
  15. Clinical Practice
  16. Masqueraders: how to identify atypical diabetes in primary care
  17. Original Article
  18. A pilot of a modified diabetes prevention program in Quito, Ecuador
  19. Clinical Image
  20. Disseminated peritoneal coccidioidomycosis
  21. Letters to the Editor
  22. Embracing industry sponsored research to expand osteopathic medical student research experiences
  23. Red reflex variations in black patients
  24. Abstracts
  25. 2021 AOA Research Abstracts and Poster Competition
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