Genitourinary aspects of disseminated coccidioidomycosis

Genitourinary involvement is common in disseminated coccidioidomycosis. Urologic evaluation should include careful examination, cultures and radiograms. The radiographic features of renal coccidioidomycosis parallel those of renal tuberculosis, with feathery, moth-eaten calices, infundibular constriction and caliceal ballooning, and eventual calcification of granulomas. Coccidioidal epididymitis may be chronic, with long asymptomatic intervals. A patient with a 15-year interval between episodes of right and left coccidioidal epipidymitis is described. Complement fixation titers should be used to determine the activity of genitourinary coccidioidomycosis. In 3 of 12 patients dissemination of coccidioidomycosis occurred during treatment with immunosuppressive medications. Renal transplant patients should be evaluated for active coccidioidomycosis prior to transplantation.