Clinical Characteristics of Coccidioidomycosis in Patients with Hepatitis C-Associated Cirrhosis

Coccidioidomycosis is a fungal infection with increased morbidity in immunocompromised populations. Patients with hepatitis C virus (HCV)-associated cirrhosis may be at increased risk because of cirrhosis-associated immune dysfunction; however, data specifically describing this intersection are limited. We conducted a retrospective chart review of patients diagnosed with coccidioidomycosis between 2010 and 2025 at a tertiary care center in Central California who had a pre-existing or concurrent diagnosis of HCV-associated cirrhosis. Demographic characteristics, clinical presentation, disease course, treatment history for HCV and coccidioidomycosis, and outcomes were reviewed. Ten patients met the inclusion criteria. Most patients were symptomatic at presentation, and half required hospitalization. Complicated pulmonary disease was common, and extrapulmonary dissemination occurred in three patients, involving the central nervous system, bone, and skin and soft tissue. Among patients who relapsed, none had received HCV treatment before the coccidioidomycosis diagnosis. Only two patients achieved sustained virologic response (SVR) before their coccidioidomycosis diagnosis, and neither relapsed. As a descriptive case series without a comparator group, this study characterizes the clinical course in this subgroup but cannot establish whether HCV-associated cirrhosis is associated with greater severity, dissemination, relapse, or mortality. These observations are hypothesis-generating and require prospective, comparative studies in larger cohorts.