Disseminated Abdominal and Pelvic Coccidioidomycosis

Abstract

Coccidioidomycosis is a fungal disease endemic to the southwestern United States caused by Coccidioides immitis resulting in a primary infection of the lung. Hematogenous dissemination occurs in less than 1% of patients, with most of them being immunocompromised. The dissemination typically seeds the skin, bone, joints, and central nervous system, but abdominal manifestations are rare. Diagnosis is difficult because presenting symptoms may be constitutional and vary with the organ and extent of involvement. We present the case of a 23-year-old African American man from Southern California with biopsy-confirmed disseminated abdominal coccidioidomycosis. The disease progressed despite treatment with traditional and novel antifungal therapy. The patient underwent extensive surgical debulking and argon laser ablation resulting in significant pain relief, improved appetite, and corresponding weight gain. Although there are indications for surgical treatment of spinal and pulmonary manifestations of the disease, no surgical indications exist for patients presenting with abdominal coccidioidomycosis.