CTICasesDisseminated Coccidioidomycosis
Imaging findings
A liver and kidney transplant recipient with worsening dyspnea, several skin lesions, and left eye pain and vision loss had a chest radiograph read as normal (retrospectively subtly abnormal) followed the next day by CT showing miliary nodules in a random distribution that touched the fissures and pleura, notably along the minor fissure, with a gradient of slightly more nodules in the upper compared to the lower lobes. Punch biopsy of a skin lesion and fundoscopic examination (showing a retinal lesion from ocular involvement) confirmed disseminated coccidioidomycosis.
Key takeaways
In an immunosuppressed transplant recipient from a coccidioidomycosis-endemic region (Central Valley), a miliary nodular pattern touching the fissures should prompt consideration of disseminated fungal infection alongside miliary tuberculosis and metastatic disease, and associated skin lesions or ocular symptoms can provide an accessible biopsy site for diagnosis; a possible (anecdotal, unconfirmed in the literature) upper-lobe predominance of miliary coccidioidomycosis nodules was discussed but not established.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Post-Bronchoscopy Hemorrhage with Bronchial Obstruction and Lobar CollapseIatrogenic
- Aggressive Vertebral HemangiomaNeoplastic
- Persistent Sciatic Artery with Infected PseudoaneurysmVascular
- Polymicrobial Tracheostomy Stoma InfectionInfection
- Mediastinitis from Infected Breast Tissue ExpanderInfection
- Allergic Bronchopulmonary Aspergillosis with Bronchocentric GranulomatosisInflammatory
- Blunt Traumatic Aortic Injury with Multifocal Thoracic and Abdominal InvolvementTrauma
- Aortic Root Pseudoaneurysms from Staphylococcal EndocarditisVascular
See all cases from June 21, 2018 →
Related Infection cases
- Mixed Fungal Infection with Mucormycosis "Bird's Nest" Sign, Aspergillus Abscess, and Candida
- Pleural Tuberculosis Mimicking Malignant Pleural Spread over Several Years
- Disseminated Mycobacterium africanum Infection with Bone and Soft-Tissue Involvement
- Fulminant Legionella pneumophila Pneumonia with Rapid Bilateral Progression
- Legionella pneumophila Round Pneumonia Mimicking Fungal Infection After Bone Marrow Transplant
- Sparse Miliary Tuberculosis with a Near-Normal Chest Radiograph