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Primary Cutaneous Coccidioidomycosis Presenting as a Recurrent Preauricular Cyst
Shayna C Rivard1, Elizabeth Satter2
1Dermatology Residency Program.
Skinmed
|June 21, 2016
Summary
A Filipino marine developed a persistent cheek nodule diagnosed as primary cutaneous coccidioidomycosis (PCC). Treatment with oral fluconazole was initiated due to potential dissemination risks.
Area of Science:
- Dermatology
- Infectious Diseases
- Mycology
Background:
- A 31-year-old Filipino active duty marine presented with a chronic, recurrent cheek nodule.
- Previous treatments included incision and drainage, and intralesional triamcinolone, with minimal improvement.
Observation:
- Physical examination revealed an erythematous, indurated nodule with a violaceous scar on the left preauricular cheek.
- Excisional biopsy demonstrated dermal fibrosis with granulomatous inflammation, including histiocytes, multinucleated giant cells, eosinophils, and spherules of Coccidioides immitis.
Findings:
- Histopathology confirmed Coccidioides immitis infection.
- Serological tests showed positive IgG antibodies for C. immitis, with low complement-fixing antibody titers (1:2) and negative IgM.
- Systemic involvement was ruled out by chest X-ray and bone scan.
Implications:
- The case highlights primary cutaneous coccidioidomycosis (PCC) as a differential diagnosis for persistent facial nodules.
- Given the patient's ethnicity and unknown infection duration, oral fluconazole was prescribed to prevent potential dissemination.
- This case underscores the importance of considering endemic fungal infections in the differential diagnosis of recalcitrant skin lesions.
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