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Case Reports

Abstract

Coccidioidomycosis is a fungal disease endemic in the Western Hemisphere that presents with a spectrum of symptoms, ranging from asymptomatic presentation to disseminated disease, the latter which is rare, affecting an estimated 1-5% of all patients with coccidioidomycosis.¹ Here, we present the case of an 11-year-old female from Southern California who presented with a two-month history of a scalp lesion with new-onset myiasis, which was eventually diagnosed as disseminated coccidioidomycosis. An 11-year-old girl with no significant past medical history presented with a small scalp nodule that continued to grow until large, ulcerated, and with maggot infestation suggestive of myiasis, despite being treated with various combinations of antibiotics and griseofulvin over the past 2 months. Debridement of the scalp wound revealed skin with pseudoepitheliomatous hyperplasia, acute and chronic granulomas, and abscess formation, as well as GMS, PAS, and gram stain highlighting thick-walled spherules of variable sizes with endospores and polymicrobial growth suggestive of coccidioidomycosis complicated by osteomyelitis. CT chest revealed bilateral tree-in-bud nodularity of the superior right and inferior left lower lobes, suggesting pulmonary involvement. The patient was treated with amphotericin B and voriconazole based on susceptibility results. The skin is one of the most common sites of disseminated coccidioidomycosis, typically involving the face, neck, scalp, or chest wall.¹  Secondary cutaneous lesions from disseminated coccidioidomycosis have a wide variety of presentations, including nodules, abscesses, verrucous plaques, and acneiform pustules.¹ Further recognition of skin manifestations of disseminated coccidioidomycosis thus is critical in order to achieve a prompt and accurate diagnosis. References: 1.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631225/