Disseminated primary coccidioidomycosis of the chest wall

Abstract

FIGURE 1. High-powered micrograph of Coccidioides species spherule in skeletal muscle tissue (circle). Pulmonary coccidioidomycosis, or valley fever, is a diagnosis with increasing incidence in the western United States. Although coccidioidomycosis is an infectious disease classically described to be endemic to the southwestern United States, the first cases were indentified in central California. One defined population that has been especially subject to this disease is residents of the greater Sacramento counties in California, with 0.1 to 5.0 cases per 100,000 population from 2001 to 2008. Coccidioidomycosis spreads through inhalation of aerosolized mold or arthroconidia. Although pulmonary (acute pneumonia, chronic progressive pneumonia, and pulmonary nodules) and certain extrapulmonary (nonmeningeal and meningitis) manifestations of coccidioidomycosis infection are well described, treatment of disseminated coccidioidomycosis presenting as chest wall disease is not. In this report we present 2 cases that illustrate the clinical presentation and treatment strategy of disseminated coccidioidomycosis infection of the chest wall.