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Disseminated coccidioidomycosis in a patient who is immunocompromised in the setting of immune reconstitution inflammatory syndrome
  1. Hamid Yaqoob,
  2. Muhammad Mohsin Munawar,
  3. Omer Salih and
  4. Anand Deonarine
  1. Internal Medicine, Howard University Hospital, Washington, DC, USA
  1. Correspondence to Dr Anand Deonarine; a_deonarine{at}


Coccidioidomycosis is a systemic fungal infection first described in 1892. More than 95% of annual cases occur in Arizona and California. It is an opportunistic infection (OI) transmitted via inhalation of airborne spores (arthroconidia) and rarely via percutaneous inoculation into a tissue or solid organ transplantation in patients who are immunocompromised and with HIV. With the advent of antiretroviral therapy (ART), the incidence of OIs has markedly reduced; however, OIs continue to occur, particularly in patients who present late for medical care or delay ART initiation. In rare cases, immunodeficient individuals may experience a paradoxical worsening or unmasking of OI symptoms, known as the immune reconstitution inflammatory syndrome (IRIS). We present a case of a 31-year-old man with disseminated coccidioidomycosis affecting the spleen, lymph nodes, lungs, bone marrow, and adrenals who developed IRIS after the initiation of ART.

  • infections
  • immunology
  • HIV / AIDS

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  • Contributors AD reviewed and updated the case report. HY wrote the abstract and discussion. MMM wrote the case and discussion. OS wrote the conclusion and contributed in collecting collateral information.

  • 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.

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

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