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Coccidioidomycosis Masquerading as Eosinophilic Ascites
Kourosh Alavi1, Pradeep R Atla1, Tahmina Haq1
1Division of Gastroenterology and Hepatology, University of California San Francisco, 1st Floor, Endoscopy Suite, 2823 Fresno Street, Fresno, CA 93721, USA.
Case Reports in Gastrointestinal Medicine
|August 13, 2015
Summary
Coccidioidomycosis, or Valley Fever, can disseminate to the peritoneum, causing eosinophilic ascites. This rare presentation requires high suspicion in endemic areas for prompt diagnosis and treatment.
Area of Science:
- Mycology
- Infectious Diseases
- Gastroenterology
Background:
- Coccidioidomycosis (Valley Fever) is a fungal infection endemic to the southwestern US, primarily affecting the lungs.
- Disseminated coccidioidomycosis is rare, typically occurring in immunocompromised individuals, and can affect various organs.
- Peritoneal involvement is an uncommon manifestation of disseminated coccidioidomycosis.
Purpose of the Study:
- To report the first case of coccidioidal dissemination to the peritoneum presenting as eosinophilic ascites (EA).
- To highlight the atypical presentation of disseminated coccidioidomycosis.
Main Methods:
- Case report of a 27-year-old male with acute abdominal pain and ascites.
- Analysis of ascitic fluid, blood work (including eosinophilia), stool studies, HIV, and tuberculosis testing.
- Abdominal imaging and endoscopic evaluation.
- Diagnosis confirmed by positive coccidioidal serology.
Main Results:
- The patient presented with ascites, significant peripheral eosinophilia (11.1%), and ascitic fluid characterized by low serum-ascites albumin gradient (SAAG) and high eosinophil count (62%).
- Initial workup for common causes of ascites and peritonitis was negative.
- Treatment with oral fluconazole led to complete symptom resolution.
Conclusions:
- Disseminated coccidioidomycosis can present atypically as peritonitis with low SAAG eosinophilic ascites.
- Eosinophilic ascites in coccidioidomycosis-endemic regions should raise suspicion for disseminated fungal infection.
- Prompt diagnosis and antifungal therapy are crucial for managing this rare complication.
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