[Tuberculosis and coccidiodomycosis in two patients without immune acquired deficiency]

Coccidioidomycosis results from inhaling the spores (arthroconidia) of Coccidioides species (Coccidioides immitis or Coccidioides posadasii). Tuberculosis is caused by the Mycobacterium tuberculosis complex, classified as acid-fast bacilli. It is most commonly transmitted from a patient with infectious pulmonary tuberculosis to other persons by droplet nuclei, which are aerosolized by coughing, sneezing, or speaking. Northern Mexico is an endemic zone for coccidioidomycosis and tuberculosis, both diseases usually appear in an isolated way. However, in cases of immunosuppressant in endemic zones, both pathologies tend to coexist. In all of the cases, determining the correct diagnosis is very difficult because they share epidemiological, clinical, radiographic, and even histopathological characteristics. In this paper we present two cases of tuberculosis and coccidioidomycosis coexistence. One case presented pulmonary disease from both entities, while the other was a relapsing of disseminated coccidioidomycosis associated with systemic tuberculosis. The presence of similar cases should alert the clinician to consider an early diagnosis of both entities in every patient with compatible clinical features. The most important concept is to remember that the diagnosis of one of them doesn't exclude the possible existence of the other.