CTICasesDisseminated Coccidioidomycosis in an Immunosuppressed Patient
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Imaging findings
An elderly, immunosuppressed lady on low-dose prednisone for seronegative rheumatoid arthritis, who frequently winters in Arizona, was transferred after two weeks of fever, cough, and malaise. Her chest radiograph showed large and very small nodules. CT revealed diffuse, almost confluent nodules throughout her lungs, some septal lines, and mediastinal lymph node enlargement. Initial cultures were misidentified as Cryptococcus and then Blastomycosis before finally confirming Coccidioidomycosis.
Key takeaways
This case highlights disseminated Coccidioidomycosis presenting with diffuse nodular lung disease and lymphadenopathy in an immunosuppressed patient with travel history to an endemic area. It emphasizes the diagnostic challenges and the critical importance of accurate microbiological identification, especially considering potential lab hazards if Coccidioides is not suspected.
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