What are less common physical findings of coccidioidomycosis?

Updated: Aug 27, 2019
  • Author: Duane R Hospenthal, MD, PhD, FACP, FIDSA, FASTMH; Chief Editor: Michael Stuart Bronze, MD  more...
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Coccidioides infection can involve virtually any organ system. At autopsy, involvement of the liver, spleen, kidney, adrenal glands, psoas muscle, heart, thyroid, and prostate has been noted. These infected sites rarely are responsible for the presenting signs or symptoms. Infection of the thyroid gland has been reported to result in a thyroid abscess and thyrotoxicosis.

Lymph node involvement can be prominent; occasionally, such cases lead to a mistaken diagnosis of lymphatic malignancy. Supraclavicular and cervical lymphadenopathy are common and probably result from lymphatic drainage from the pulmonary infection site. Lymphadenopathy may be generalized, and associated drainage from contiguous lesions is not unusual.

In a minority of patients, splenic enlargement is clinically apparent. Hepatic involvement with prominently elevated alkaline phosphatase levels is common in the context of widespread disease. Hepatic infection is usually asymptomatic but can be part of a hepatic-pulmonary syndrome with a brief hepatitis-like illness, hepatic granulomas, and eosinophilia.

Coccidioidal infection of the biliary tree is uncommon but has been reported to present as abdominal pain and obstructive jaundice. Intestinal obstruction and peritonitis have also been reported to be secondary to coccidioidal infection. [41]

Cardiovascular complications account for an extremely small percentage of clinical presentations. In the rare cases in which they do occur, however, they can be devastating. Pericardial effusions and can produce cardiovascular compromise and tamponade in extreme cases. [42] Myocardial involvement is most often discovered at autopsy.

Urinary tract involvement is rare (with the exception of asymptomatic coccidiuria) and is usually found in the setting of widely disseminated disease. The prostate may serve as a nidus of infection and has been implicated as a source of urinary cultures that are positive for the Coccidioides organism. Involvement of the ovaries and testicles is very uncommon.

Ocular coccidioidomycosis is rare but is probably underappreciated. Ocular involvement usually occurs in the context of disseminated disease. Ocular coccidioidomycosis can present as a lacrimal gland fossa mass or with eye pain, photophobia, and other symptoms of chorioretinitis or iridocyclitis. Anterior uveitis and posterior uveitis (choroiditis and chorioretinitis) are uncommon, and endophthalmitis is rare and can occur without systemic involvement. [43]

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