J Pediatr Infect Dis 2014; 09(02): 109-114
DOI: 10.3233/JPI-140421
Case Report
Georg Thieme Verlag KG Stuttgart – New York

Mimicking the great mimicker: Disseminated coccidioidomycosis masquerading as classic tuberculosis

Dayna Chin
a  Children's Hospital of Orange County and University of California, Irvine, CA, USA
,
Kimberly Wada
a  Children's Hospital of Orange County and University of California, Irvine, CA, USA
,
W. Nathan Holmes
b  Department of Radiology, Children's Hospital of Orange County, Orange CA, USA
,
Jasjit Singh
c  Department of Infectious Diseases, Children's Hospital of Orange County, Orange CA, USA
› Institutsangaben

Verantwortlicher Herausgeber dieser Rubrik:
Weitere Informationen

Publikationsverlauf

28. März 2014

12. Mai 2014

Publikationsdatum:
28. Juli 2015 (online)

Abstract

A correct diagnosis can be elusive when a rare disease is present. Such was the case when two teenagers were admitted to a children's hospital. Due to their clinical presentation, imaging, and laboratory results, final diagnoses and treatment were delayed. The first patient, a 15-year old Chinese female with systemic lupus erythematosus, presented with cough and fever. She was found to have a right upper lobe consolidation with central cavitation. Subsequent chest imaging revealed a miliary pattern, and RIPE therapy was started to cover Mycobacterium tuberculosis. The second patient was a previously healthy, 14-year old African American female, who presented with progressive spinal deformity and an enlarging right parietal scalp lesion. An AFB sputum sample was positive, and spinal imaging showed a gibbus deformity, prompting the initiation of RIPE therapy for tuberculosis. Both patients were later found to have disseminated Coccidioidomycosis, a rare diagnosis that is often mistaken for other etiologies. Both patients responded well to fluconazole therapy.