A Case of Coccidioidomycosis Showing Cutaneous and Pulmonary Nodules

Park, Dong Jae; Jang, Yun Hwan; Lee, Seok Jong; Na, Gun Yeon; Kim, Do Won; Kim, Sin Woo

Abstract

Coccidioidomycosis is a systemic infection caused by inhalation of airborne spores of Coccidioides immitis, a fungus found in soil in the southwestern area of United States and in parts of Mexico and South America. Although its human infection has not been reported infrequently in nonendemic areas, it has rarely been done in Korea since first report of a case of systemic coccidioidomycosis with cutaneous lesions. The patient was a 32-year-old male with granulating cutaneous nodules on left side of upper back for 1 month. Three months ago, he had stayed at northern area of Mexico for 2 months with mild transient upper respiratory symptoms during his stay. After he returned to Korea, cervical lymphadenopathy and skin lesions developed. He had also respiratory symptoms such as chest discomfort and mild chest pain and chest X-ray revealed a solitary nodule. The cutaneous nodules of walnut size were removed surgically and he was recieved daily oral medication of itraconazole 400 mg for 10 months showing good clinical response. Even though lung nodule was not disappeared in radiological exam, repeated CT guided biopsy and fungal tissue culture of lung nodule were undertaken with no growth throughout 10 months. After 10 months itraconazole therapy, there was no evidence of clinical relapse and no change on chest film for following 16 months. We report a case of disseminated coccidioidomycosis involving lung, skin and lymph node simmultaneously and successfully treated with both surgical excision and systemic antifungal therapy.