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Case report
Coccidioides in lung transplant: case report
  1. Mark Anthony Diaz1,
  2. Maria Luisa Bayo2,
  3. Francisco Alvarez1 and
  4. Salvador Alvarez1
  1. 1Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
  2. 2University of Navarra, Pamplona, Navarra, Spain
  1. Correspondence to Dr Salvador Alvarez; salvarez{at}mayo.edu

Abstract

A middle-aged woman was hospitalised for generalised, painful skin lesions 6 weeks after a successful double-lung transplant. She had end-stage lung disease associated with chronic obstructive pulmonary disease due to alpha-1 antitrypsin deficiency, and she had been treated with itraconazole for 16 months because of lung infection associated with Malbranchea spp. Results of a skin biopsy of the initial lesion on her arm showed non-specific dermal inflammation, presumably due to reactivation of the Malbranchea spp infection. Follow-up cervical lymph node biopsy and culture showed Coccidioides posadasii/C. immitis. A detailed review of her travel history showed a 4-month stay in Arizona as a teenager that she barely remembered. Coccidioides spp were likely misidentified as Malbranchea spp owing to similar morphological characteristics. Dosages of immunosuppressive medications were reduced, and antifungal therapy was changed to posaconazole. Her skin lesions resolved.

  • dermatology
  • transplantation
  • infectious diseases
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Footnotes

  • Contributors MAD: conceived and designed the analysis, collected the data, contributed data or analysis tools, performed the analysis, wrote the paper, main author and writer; MLB: conceived and designed the analysis, collected the data, research of related literature, contributed data or analysis tools, performed the analysis, wrote the paper, helped write the Discussion section; SA: conceived and designed the analysis, collected the data, contributed data or analysis tools, performed the analysis, helped analyse and treat the infection from transplant ID standpoint, wrote the paper, edited the case presentation and the Discussion section of the paper; FA: conceived and designed the analysis, collected the data, contributed data or analysis tools, performed the analysis, wrote the paper, provided analysis for discussion and management of transplant immunosuppression.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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