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Coccidioidomycosis lymphadenopathy: an unusual presentation
  1. Keerthika Sri,
  2. Anandraj Vaithy,
  3. Shanmugasamy Kathirvelu and
  4. Sowmya Srinivasan
  1. Sri Balaji Vidyapeeth, Pathology, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India
  1. Correspondence to Dr Anandraj Vaithy; anandrajk{at}


Coccidioidomycosis is known to occur around the western hemisphere. In tropical countries, the clinical presentation is atypical presenting with a superficial abscess preceded by respiratory tract involvement often mimicking tuberculosis. Eliciting a history of exposure and high suspicion is imperative for early diagnosis.

In the present case report, a man in his early 30s presented with complaints of swelling over the neck for the past 2 months with a recent travel history. With a provisional clinical diagnosis of tuberculosis, a biopsy of the swelling revealed features of granulomas with non-caseating necrosis with Coccidioidomycosis organisms demonstrated by fungal stains. Fungal culture and serology reiterated Coccidioides and he recovered after a course of fluconazole.

The case report concludes with a statement that Coccidioidomycosis is known to manifest with lymphadenitis mimicking tuberculosis and must be taken into account as one of the differentials. The current report is presented for its rarity in India with atypical presentation.

  • infections
  • infectious diseases

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  • Contributors Dr KS, Dr AV and Dr SS were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content. Dr SK, Dr SS and Dr AV gave final approval of the manuscript. Dr KS contributed in providing substantial inputs to the concept and design of the article as well as directly involved in patient’s care. Contributed a vital role in work up and follow-up of the case in coordination with laboratory aspects and clinicians and meticulous planning in drafting the article, and performed data interpretation and effective functioning in providing the complete patient care until recovery of the symptoms. Dr AV contributed in providing a key role in conduction, organising the case right from the presentation, complete work up, laboratory analysis and interpretation of laboratory aspects and conveying and coordinating the rare and unusual presentation of the case including 'breaking the news' to the patient. Also played the role of team leader aminating group dynamics and mentoring. Dr SK contributed in vetting the manuscript, approving the results, quality control aspects in affirming the diagnosis work up of the article in drafting, editing and data analysis and played a role in integrity of the article. Dr SS helped in acquisition of data and analysis, reaffirming the diagnosis in accordance with literature aspects, interpretation of clinic-pathological aspects, reporting of the special stain sections and, hierarchical approval of the rare presentations.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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