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Coccidioides immitis Cervical Lymphadenitis Complicated by Esophageal Fistula
Michael Loudin1, Daniel R Clayburgh2, Morgan Hakki3
1Department of Internal Medicine, Oregon Health and Science University, Portland, OR 97239, USA.
Abstract:
Coccidioidomycosis (valley fever) is caused by the dimorphic fungi Coccidioides immitis or Coccidioides posadasii. Most infections are asymptomatic or result in self-limited pneumonia; extrapulmonary dissemination via either hematogenous or lymphatic spread is rare. Here, we present a case of cervical C. immitis lymphadenitis that resulted in fistula formation to the esophagus via mediastinal extension. This case highlights a very unusual extrapulmonary manifestation of coccidioidomycosis, the difficulty in diagnosing coccidioidal infection when it is not suspected, and the importance of obtaining a thorough exposure history to assist with diagnosis.
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