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Case Report

Pandora’s Box: Disseminated Coccidioidomycosis Associated with Self-Medication with an Unregulated Potent Corticosteroid Acquired in Mexico

by
Alejandro Jose Coba
1,
Patricia K. Sallee
2,
Danielle O. Dixon
2,
Rahaf Alkhateb
3 and
Gregory M. Anstead
2,4,*
1
San Antonio Infectious Diseases Associates, 8042 Wurzbach Road, San Antonio, TX 78229, USA
2
Division of Infectious Diseases, Department of Medicine, University of Texas Health, San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229, USA
3
Department of Pathology and Laboratory Medicine, University of Texas Health, San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229, USA
4
Division of Infectious Diseases, Medical Service, South Texas Veterans Healthcare System, 7400 Merton Minter Blvd, San Antonio, TX 78229, USA
*
Author to whom correspondence should be addressed.
Trop. Med. Infect. Dis. 2021, 6(4), 207; https://doi.org/10.3390/tropicalmed6040207
Submission received: 2 October 2021 / Revised: 3 November 2021 / Accepted: 28 November 2021 / Published: 5 December 2021
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Abstract

Coccidioidomycosis (CM), caused by the dimorphic fungi Coccidioides immitis and C. posadasii, typically presents as acute or chronic pulmonary disease. However, disseminated disease occurs in about 1% of patients. Disseminated CM may affect multiple organ systems, including cutaneous, osteoarticular, and central nervous system sites. Here, we present a case of disseminated CM in a patient from a border city in Texas. The patient had a history of uncontrolled diabetes mellitus and was also taking an over-the-counter medication acquired in Mexico that contained a potent corticosteroid. The patient presented with seizures and was found to have a brain infarct, cavitary lung lesions, synovitis of the knee, multiple skin lesions, and chorioretinitis. The patient had a very high complement fixation titer for Coccidioides; fungal spherules were seen in a skin biopsy specimen, and Coccidioides grew in culture from a sample of synovial fluid and the skin biopsy specimen. This case illustrates the dissemination potential of Coccidioides, the danger of unregulated pharmaceuticals, the importance of thorough history taking, and recognizing risk factors that contribute to disseminated CM.
Keywords: disseminated coccidioidomycosis; corticosteroid; cutaneous coccidioidomycosis; coccidioidal synovitis; pulmonary coccidioidomycosis; coccidioidal chorioretinitis disseminated coccidioidomycosis; corticosteroid; cutaneous coccidioidomycosis; coccidioidal synovitis; pulmonary coccidioidomycosis; coccidioidal chorioretinitis

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MDPI and ACS Style

Coba, A.J.; Sallee, P.K.; Dixon, D.O.; Alkhateb, R.; Anstead, G.M. Pandora’s Box: Disseminated Coccidioidomycosis Associated with Self-Medication with an Unregulated Potent Corticosteroid Acquired in Mexico. Trop. Med. Infect. Dis. 2021, 6, 207. https://doi.org/10.3390/tropicalmed6040207

AMA Style

Coba AJ, Sallee PK, Dixon DO, Alkhateb R, Anstead GM. Pandora’s Box: Disseminated Coccidioidomycosis Associated with Self-Medication with an Unregulated Potent Corticosteroid Acquired in Mexico. Tropical Medicine and Infectious Disease. 2021; 6(4):207. https://doi.org/10.3390/tropicalmed6040207

Chicago/Turabian Style

Coba, Alejandro Jose, Patricia K. Sallee, Danielle O. Dixon, Rahaf Alkhateb, and Gregory M. Anstead. 2021. "Pandora’s Box: Disseminated Coccidioidomycosis Associated with Self-Medication with an Unregulated Potent Corticosteroid Acquired in Mexico" Tropical Medicine and Infectious Disease 6, no. 4: 207. https://doi.org/10.3390/tropicalmed6040207

APA Style

Coba, A. J., Sallee, P. K., Dixon, D. O., Alkhateb, R., & Anstead, G. M. (2021). Pandora’s Box: Disseminated Coccidioidomycosis Associated with Self-Medication with an Unregulated Potent Corticosteroid Acquired in Mexico. Tropical Medicine and Infectious Disease, 6(4), 207. https://doi.org/10.3390/tropicalmed6040207

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