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Disseminated coccidioidomycosis presenting as eosinophilic ascites
Kirk Brant Fetters1, David Fernandez-Hazoury2, Sava Grujic2
1Department of Medicine, Harbor-UCLA Medical Center, Torrance, California, USA.
BMJ Case Reports
|April 15, 2025
Summary
A rare case of peritoneal coccidioidomycosis presented as suspected spontaneous bacterial peritonitis (SBP). Diagnosis was confirmed via omental biopsy, and high-dose fluconazole effectively treated the infection.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Pathology
Background:
- Spontaneous bacterial peritonitis (SBP) is a common complication in patients with cirrhosis and ascites.
- Eosinophilic ascites is an uncommon finding that necessitates a broad differential diagnosis.
Purpose of the Study:
- To report a rare case of peritoneal coccidioidomycosis mimicking SBP in a patient with cirrhosis.
- To highlight the importance of considering uncommon etiologies in eosinophilic ascites.
Main Methods:
- A 50s male with cirrhosis presented with suspected SBP.
- Ascitic fluid analysis revealed eosinophilia and a low serum-ascites albumin gradient.
- Omental biopsy confirmed coccidioidomycosis.
Main Results:
- Empirical SBP treatment was ineffective.
- Extensive malignancy work-up was negative.
- High-dose fluconazole therapy led to complete resolution of ascites and abdominal pain.
Conclusions:
- Peritoneal coccidioidomycosis is a rare but treatable cause of eosinophilic ascites in immunocompromised individuals.
- Eosinophilia in ascitic fluid warrants investigation for unusual infections like coccidioidomycosis, tuberculosis, helminthic infections, or eosinophilic gastrointestinal diseases.
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