Diagnosis of disseminated coccidioidomycosis by liver biopsy

The liver is commonly involved at autopsy in disseminated coccidioidomycosis, but it is distinctly unusual to diagnose disseminated coccidioidal disease by a liver biopsy. We describe three patients with hepatic coccidioidomycosis diagnosed by liver biopsy in addition to the four previously reported cases in the literature. Most patients had a hepatitislike illness with pulmonary infiltrates of short duration. Hepatomegaly and/or abnormal liver function test results were present in six of seven patients. All patients had an abnormal chest roentgenogram. Eosinophilia was found in five patients. Every biopsy specimen showed evidence of granulomas containing readily identifiable coccidioidallike spherules. The condition of six of seven patients improved following therapy and only one died. Hepatic coccidioidomycosis is an unusual manifestation of dissemination that is commonly a hepatic-pulmonary syndrome with eosinophilia. The diagnosis is readily made with liver biopsy, and the outcome may be more favorable than other forms of dissemination.