TY - JOUR T1 - Disseminated coccidioidomycosis in a patient who is immunocompromised in the setting of immune reconstitution inflammatory syndrome JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2018-227217 VL - 14 IS - 4 SP - e227217 AU - Hamid Yaqoob AU - Muhammad Mohsin Munawar AU - Omer Salih AU - Anand Deonarine Y1 - 2021/04/01 UR - http://casereports.bmj.com/content/14/4/e227217.abstract N2 - 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. ER -