Mimicking the great mimicker: Disseminated coccidioidomycosis masquerading as classic tuberculosis

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.

Keywords

Coccidioidomycosis - tuberculosis - disseminated - immunocompromised - cavitary lesion - Coccidioides immitis - miliary