A Case of Reactivated Disseminated Coccidioidomycosis in an Elderly Patient

Reactivation of extrapulmonary disseminated coccidioidomycosis infection is rare. When it does happen, it often happens soon after the primary infection. Reactivation of latent disease is usually seen in patients who later become immunocompromised. Here we discuss a case of an 88-year-old male patient with a distant history of extrapulmonary coccidioidomycosis infection 50 years prior, who developed reactivated coccidioidomycosis presenting as a soft tissue mass in his arm and new polyarthritis. Despite rapid initiation of fluconazole treatment, the patient struggled with his recovery, which was complicated by deep vein thrombosis (DVT) and deconditioning at his age. We believe our patient's age, gender, and comorbidities were contributing factors for his reactivation and disseminated disease. This case illustrates the importance of having a high index of suspicion for reactivation of disease despite a long latent period.