An Incidental Finding and Unusual Presentation of Atypical Coccidioidomycosis in a 72-Year-Old Man: A Case Report  

作　　者：Alise Haddad Ethan Dimock Joseph Hanna Rafi Haddad Michel Hanna Stephen Galens Alise Haddad;Ethan Dimock;Joseph Hanna;Rafi Haddad;Michel Hanna;Stephen Galens(William Beaumont School of Medicine, Oakland University, Rochester, USA;St. George’s University, Grenada, USA;Faculty of Medicine and Medical Sciences, University of Balamand, Balamand, Lebanon;Division of Infectious Disease, Department of Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA)

机构地区：[1]William Beaumont School of Medicine, Oakland University, Rochester, USA [2]St. George’s University, Grenada, USA [3]Faculty of Medicine and Medical Sciences, University of Balamand, Balamand, Lebanon [4]Division of Infectious Disease, Department of Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA

出　　处：《Case Reports in Clinical Medicine》2023年第9期357-361,共5页临床医学病理报告（英文）

摘　　要：This case report presents an unusual and challenging diagnostic scenario involving a 72-year-old man who recently returned from a trip to Maui, Hawaii. While in Maui, the patient presented with a fever and fatigue that resolved spontaneously. However, he had an observable rash on his head and was given a steroid injection to resolve the rash. Later on his trip, the patient experienced a dry, nonproductive cough which resolved with a five-day course of prednisone. While visiting Michigan, the patient began to experience neck pain and visited Troy Beaumont Hospital for further treatment. Meningitis tests were negative. Vancomycin was given due to the detection of gram positive coccidioidomycosis in the culture, but this was later proven to be a contaminant. Coccidiomycosis does not initially have specific symptoms. Despite negative coccidioidomycosis antigen tests, the patient exhibited features more consistent with blastomycosis and cryptococcus, highlighting the complexities of diagnosing fungal infections with atypical presentations. The case emphasizes the importance of considering alternative fungal pathogens native to endemic regions and pursuing comprehensive diagnostic measures to establish an accurate diagnosis. Lastly, the discussion about recommendations for antifungal therapy and preventative measures for individuals at risk of respiratory fungal infections is critically important for the advancement of early detection of fungal infections.This case report presents an unusual and challenging diagnostic scenario involving a 72-year-old man who recently returned from a trip to Maui, Hawaii. While in Maui, the patient presented with a fever and fatigue that resolved spontaneously. However, he had an observable rash on his head and was given a steroid injection to resolve the rash. Later on his trip, the patient experienced a dry, nonproductive cough which resolved with a five-day course of prednisone. While visiting Michigan, the patient began to experience neck pain and visited Troy Beaumont Hospital for further treatment. Meningitis tests were negative. Vancomycin was given due to the detection of gram positive coccidioidomycosis in the culture, but this was later proven to be a contaminant. Coccidiomycosis does not initially have specific symptoms. Despite negative coccidioidomycosis antigen tests, the patient exhibited features more consistent with blastomycosis and cryptococcus, highlighting the complexities of diagnosing fungal infections with atypical presentations. The case emphasizes the importance of considering alternative fungal pathogens native to endemic regions and pursuing comprehensive diagnostic measures to establish an accurate diagnosis. Lastly, the discussion about recommendations for antifungal therapy and preventative measures for individuals at risk of respiratory fungal infections is critically important for the advancement of early detection of fungal infections.

关 键 词：COCCIDIOIDOMYCOSIS BLASTOMYCOSIS CRYPTOCOCCUS Fungal Infections Diagnostic Challenges Atypical Presentation 

分 类 号：R73[医药卫生—肿瘤]