Fatal coccidioidomycosis involving the lungs, brain, tongue, and adrenals in a cirrhotic patient. An autopsy case
David Chee,
August W. Moritz,
Amanda P. Profit,
Apeksha N. Agarwal,
Gregory M. Anstead
Affiliations
David Chee
San Antonio Infectious Diseases Consultants, 8042 Wurzbach Road, San Antonio, TX, 78229, United States
August W. Moritz
Methodist Hospital, 7700 Floyd Curl, San Antonio, TX, 78229, United States
Amanda P. Profit
Medical City Dallas Hospital, 7777 Forest Ln, Suite A-200, Dallas, TX, 75230, United States
Apeksha N. Agarwal
Department of Pathology, University of Texas Health, 7703 Floyd Curl Drive, San Antonio, TX, 78229, United States
Gregory M. Anstead
Medical Service, Division of Infectious Diseases, South Texas Veterans Healthcare System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, United States; Department of Medicine, Division of Infectious Diseases, University of Texas Health, 7703 Floyd Curl Dr, San Antonio, TX, 78229, United States; Corresponding author at: Medical Service, Division of Infectious Diseases, South Texas Veterans Healthcare System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, United States.
In this paper, we describe a case of fatal disseminated coccidioidomycosis (CM). The patient was a 44-year old male with a history of cirrhosis who presented with altered mental status, cough, and an enlarged, ulcerated tongue. On evaluation, the patient was found to have coccidioidal infection of the tongue, lungs, and brain. Despite over two months of antifungal treatment, the patient died from aspiration pneumonia and at autopsy was found to have persistent infection of the tongue and lungs, extensive mycosis of the brain, and involvement of both adrenal glands. The fulminant course of coccidioidomycosis in this patient is ascribed to his baseline cirrhosis and lymphocytopenia. There are few autopsy cases of CM that have been described in the post-antifungal era and few published cases of CM with either tongue or adrenal involvement.
