All That Coughs Is Not COVID-19: A Delayed Diagnosis of Disseminated Coccidioidomycosis Following Severe Acute Respiratory Syndrome Coronavirus 2 Infection

Joshua C Chen; Darren Wong; Sina Rabi; Scott Worswick; Brittney DeClerck; Jean Gibb

doi:10.1093/ofid/ofab246

All That Coughs Is Not COVID-19: A Delayed Diagnosis of Disseminated Coccidioidomycosis Following Severe Acute Respiratory Syndrome Coronavirus 2 Infection

Open Forum Infect Dis. 2021 May 19;8(7):ofab246. doi: 10.1093/ofid/ofab246. eCollection 2021 Jul.

Authors

Joshua C Chen¹, Darren Wong¹, Sina Rabi², Scott Worswick², Brittney DeClerck³, Jean Gibb¹

Affiliations

¹ Division of Infectious Disease, University of Southern California, Los Angeles, California, USA.
² Department of Dermatology, University of Southern California, Los Angeles, California, USA.
³ Department of Pathology, University of Southern California, Los Angeles, California, USA.

Abstract

Coccidioides immitis (and Coccidioides posadasii) are endemic fungi of the southwestern United States and northern Mexico. Uncomplicated, symptomatic Coccidioides infection most commonly causes a self-limited pneumonia; however, immunocompromised patients can manifest severe pneumonia with an additional risk of dissemination to bone, joints, soft tissues, and in the most severe cases, the central nervous system. In 2020, clinicians were challenged with a previously unseen volume of acute respiratory complaints as a result of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. We present a patient with respiratory failure secondary to SARS-CoV-2 who experienced prolonged hypoxia and neurologic deterioration, eventually leading to a diagnosis of occult disseminated coccidiomycosis involving meningitis, miliary-pattern pneumonia, and cutaneous lesions.

Keywords: COVID-19; SARS-CoV-2; coccidiodomycosis; coinfection; valley fever.

Publication types

Case Reports