PT  - JOURNAL ARTICLE
AU  - Mark Anthony Diaz
AU  - Maria Luisa Bayo
AU  - Francisco Alvarez
AU  - Salvador Alvarez
TI  - <em>Coccidioides</em> in lung transplant: case report
AID  - 10.1136/bcr-2019-230888
DP  - 2020 Apr 01
TA  - BMJ Case Reports
PG  - e230888
VI  - 13
IP  - 4
4099  - http://casereports.bmj.com/content/13/4/e230888.short
4100  - http://casereports.bmj.com/content/13/4/e230888.full
SO  - BMJ Case Reports2020 Apr 01; 13
AB  - 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.