Coccidioidomycosis Masquerading as Eosinophilic Ascites
Endemic to the southwestern parts of the United States, coccidioidomycosis, also known as “Valley Fever,” is a common fungal infection that primarily affects the lungs in both acute and chronic forms. Disseminated coccidioidomycosis is the most severe but very uncommon and usually occurs in immunoco...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2015-01-01
|
| Series: | Case Reports in Gastrointestinal Medicine |
| Online Access: | http://dx.doi.org/10.1155/2015/891910 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832562458325155840 |
|---|---|
| author | Kourosh Alavi Pradeep R. Atla Tahmina Haq Muhammad Y. Sheikh |
| author_facet | Kourosh Alavi Pradeep R. Atla Tahmina Haq Muhammad Y. Sheikh |
| author_sort | Kourosh Alavi |
| collection | DOAJ |
| description | Endemic to the southwestern parts of the United States, coccidioidomycosis, also known as “Valley Fever,” is a common fungal infection that primarily affects the lungs in both acute and chronic forms. Disseminated coccidioidomycosis is the most severe but very uncommon and usually occurs in immunocompromised individuals. It can affect the central nervous system, bones, joints, skin, and, very rarely, the abdomen. This is the first case report of a patient with coccidioidal dissemination to the peritoneum presenting as eosinophilic ascites (EA). A 27-year-old male presented with acute abdominal pain and distention from ascites. He had eosinophilia of 11.1% with negative testing for stool studies, HIV, and tuberculosis infection. Ascitic fluid exam was remarkable for low serum-ascites albumin gradient (SAAG), PMN count >250/mm3, and eosinophils of 62%. Abdominal imaging showed thickened small bowel and endoscopic testing negative for gastric and small bowel biopsies. He was treated empirically for spontaneous bacterial peritonitis, but no definitive diagnosis could be made until coccidioidal serology returned positive. We noted complete resolution of symptoms with oral fluconazole during outpatient follow-up. Disseminated coccidioidomycosis can present in an atypical fashion and may manifest as peritonitis with low SAAG EA. The finding of EA in an endemic area should raise the suspicion of coccidioidal dissemination. |
| format | Article |
| id | doaj-art-3447114ab0484f54ae094ce3fb775082 |
| institution | Kabale University |
| issn | 2090-6528 2090-6536 |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Gastrointestinal Medicine |
| spelling | doaj-art-3447114ab0484f54ae094ce3fb7750822025-02-03T01:22:30ZengWileyCase Reports in Gastrointestinal Medicine2090-65282090-65362015-01-01201510.1155/2015/891910891910Coccidioidomycosis Masquerading as Eosinophilic AscitesKourosh Alavi0Pradeep R. Atla1Tahmina Haq2Muhammad Y. Sheikh3Division of Gastroenterology and Hepatology, University of California San Francisco, 1st Floor, Endoscopy Suite, 2823 Fresno Street, Fresno, CA 93721, USADivision of Gastroenterology and Hepatology, University of California San Francisco, 1st Floor, Endoscopy Suite, 2823 Fresno Street, Fresno, CA 93721, USADivision of Gastroenterology and Hepatology, University of California San Francisco, 1st Floor, Endoscopy Suite, 2823 Fresno Street, Fresno, CA 93721, USADivision of Gastroenterology and Hepatology, University of California San Francisco, 1st Floor, Endoscopy Suite, 2823 Fresno Street, Fresno, CA 93721, USAEndemic to the southwestern parts of the United States, coccidioidomycosis, also known as “Valley Fever,” is a common fungal infection that primarily affects the lungs in both acute and chronic forms. Disseminated coccidioidomycosis is the most severe but very uncommon and usually occurs in immunocompromised individuals. It can affect the central nervous system, bones, joints, skin, and, very rarely, the abdomen. This is the first case report of a patient with coccidioidal dissemination to the peritoneum presenting as eosinophilic ascites (EA). A 27-year-old male presented with acute abdominal pain and distention from ascites. He had eosinophilia of 11.1% with negative testing for stool studies, HIV, and tuberculosis infection. Ascitic fluid exam was remarkable for low serum-ascites albumin gradient (SAAG), PMN count >250/mm3, and eosinophils of 62%. Abdominal imaging showed thickened small bowel and endoscopic testing negative for gastric and small bowel biopsies. He was treated empirically for spontaneous bacterial peritonitis, but no definitive diagnosis could be made until coccidioidal serology returned positive. We noted complete resolution of symptoms with oral fluconazole during outpatient follow-up. Disseminated coccidioidomycosis can present in an atypical fashion and may manifest as peritonitis with low SAAG EA. The finding of EA in an endemic area should raise the suspicion of coccidioidal dissemination.http://dx.doi.org/10.1155/2015/891910 |
| spellingShingle | Kourosh Alavi Pradeep R. Atla Tahmina Haq Muhammad Y. Sheikh Coccidioidomycosis Masquerading as Eosinophilic Ascites Case Reports in Gastrointestinal Medicine |
| title | Coccidioidomycosis Masquerading as Eosinophilic Ascites |
| title_full | Coccidioidomycosis Masquerading as Eosinophilic Ascites |
| title_fullStr | Coccidioidomycosis Masquerading as Eosinophilic Ascites |
| title_full_unstemmed | Coccidioidomycosis Masquerading as Eosinophilic Ascites |
| title_short | Coccidioidomycosis Masquerading as Eosinophilic Ascites |
| title_sort | coccidioidomycosis masquerading as eosinophilic ascites |
| url | http://dx.doi.org/10.1155/2015/891910 |
| work_keys_str_mv | AT kouroshalavi coccidioidomycosismasqueradingaseosinophilicascites AT pradeepratla coccidioidomycosismasqueradingaseosinophilicascites AT tahminahaq coccidioidomycosismasqueradingaseosinophilicascites AT muhammadysheikh coccidioidomycosismasqueradingaseosinophilicascites |