A RARE CASE OF LABORATORY-CONFIRMED COCCIDIOIDOMYCOSIS IN BULGARIA, OCCURRING AFTER A 20-YEAR INTERVAL

Coccidioidomycosis is a systemic fungal infection with no local distribution in Europe , associated with travelling to endemic regions of the world. The disease is defined as local but of global importance due to the increasing number of travellers to endemic areas. We present a rare case of coccidioidomycosis in a 52-year-old woman living in the state of Arizona, USA. The patient had no disease symptoms, but computed axial tomography performed at the annual follow-up showed a small dense mass in the right lung. Positron emission tomography was also performed for suspicion of neoplasia, without conclusive evidence of malignancy. On her annual holiday in Bulgaria, the woman decided to consult a microbiologist at the National Centre of Infectious and Parasitic Diseases in Sofia, based on her information about the disease and the regions at risk of infection. The patient was referred to a consultation with a pulmonologist. As recommended by the pulmonologist, the lung nodule was surgically removed and subsequent histological and microbiological studies (Sabouraud agar medium culture) confirmed the diagnosis of coccidioidomycosis. This is only the second case of this systemic mycosis registered in Bulgaria, showing that the diagnosis is difficult due to the lack of specific symptoms. A multidisciplinary approach is essential for the rapid diagnosis and timely treatment, which in turn is a prerequisite for a favorable outcome of the disease.