Coccidioidomycosis Lymphadenitis in a patient with lupus nephritis: a case report

Coccidioidomycosis is a fungal infection endemic to arid regions. Although it usually presents as a pulmonary infection, extrapulmonary dissemination is rare, and cervical lymphadenitis is even more unusual with fewer than five cases reported in the literature. Diagnosis of this disease remains a clinical challenge due to its rarity and similarity to other clinical entities. A 34-year-old woman with lupus nephritis on immunosuppressive therapy presented with a painful cervical mass associated with unquantified fever of six weeks of evolution. The patient is a resident of Coahuila, Mexico, in a region adjacent to the Texas-Mexico border. Diagnostic imaging and excisional biopsy with histopathology and culture confirmed cervical lymphadenitis due to Coccidioides. Treatment with oral fluconazole (Diflucan) was started, achieving complete clinical resolution after 12 months. This case highlights the importance of considering different fungal infections in immunocompromised patients presenting with lymphadenopathy. Early diagnosis by biopsy and culture, as well as specific antifungal treatment are essential to obtain favorable results.