A multifaceted presentation of disseminated coccidioidomycosis: A case review

Introduction: Coccidioidomycosis, commonly known as Valley fever, is an infectious disease caused by two highly virulent fungi, Coccidioides immitis and C. posadasii. Around 60% of the infections are asymptomatic, however one-third of the cases develop pulmonary infection. About 0.5–2% of the cases disseminate to extrapulmonary locations which can be skin, bones/joints, and central nervous system, frequently seen in immunocompromised individuals (e.g., transplant recipients, HIV patients, pregnancy, diabetics, and patients on steroids). Case Report: We report a case of coccidioidomycosis in a 33-year-old diabetic male who presented with extrapulmonary manifestations involving thigh and facial skin followed by right chest wall complex collection which disseminated further to rib bone. The patient was found to be non-compliant on his antifungal drug regime which ultimately led to dissemination of the infection in the setting of preexisting diabetes. Following a surgical debridement procedure of the chest wall lesion and rib excision in addition with compliant antifungal regime led to eradication of the infection. Conclusion: The diagnosis of coccidioidomycosis relies upon clinical suspicion, laboratory findings (serology, cultures, and histopathology) coupled with imaging findings. The key to eradicating infection is ultimately based on an appropriate course of antifungal antibiotics and patient compliance following an accurate and timely recognition of the infection.