Title : Peritoneal coccidioidomycosis presenting as treatment resistant tuberculosis
Abstract:
We present a case of peritoneal coccidioidomycosis in an immunocompetent female patient initially diagnosed with tuberculosis at an outside hospital who presented with suspected RIPE therapy failure. She presented with a history of recurrent ascites, headaches, and shortness of breath. She underwent bronchoscopy, paracentesis, and lumbar puncture, which respectively revealed hilar lymph node aspirate, peritoneal fluid, and cerebrospinal fluid, all positive for Coccidioides and negative for Tuberculosis. Extrapulmonary or disseminated coccidioidomycosis occurs only in approximately 1% of patients and typically involves the skin, bone, or meninges. This case underscores the importance of reconsidering the diagnosis in patients who have seemingly failed RIPE therapy in regions where Coccidioides is endemic. Accurate diagnosis and appropriate antifungal therapy led to inpatient treatment with amphotericin B and plan for indefinite fluconazole and outpatient ID follow up after discharge. Unfortunately, the patient was lost to follow up. Overall, this case contributes to existing literature by highlighting diagnostic challenges and the importance of broadening the differential in endemic regions when treatment is not leading to symptom resolution.
