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Thank you for accepting our invitation to present your abstract "An Unusual Presentation of Coccidioidomycosis with Peritoneal Involvement in an Immunocompetent Individual". Your response has been recorded by the SAGES office.
Abstract ID: 84804
Abstract Title: An Unusual Presentation of Coccidioidomycosis with Peritoneal Involvement in an Immunocompetent Individual
Session Name: iPoster Session (Non CME)
Program Number: Program Number will be assigned in January 2018
Session Date: Thursday, April 12, 2018 and Friday, April 13, 2018
Session Time: 10:00 AM - 4:00 PM
Presenter: Joseph D Krocker // firstname.lastname@example.org // 8179394669
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All accepted abstracts will be published by the journal Surgical Endoscopy.
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AN UNUSUAL PRESENTATION OF COCCIDIOIDOMYCOSIS WITH PERITONEAL INVOLVEMENT IN AN IMMUNOCOMPETENT INDIVIDUAL
Joseph D Krocker1, Benjamin Clapp, MD, FACS2 ; 1The Texas Tech Health Sciences Center Paul L Foster School of Medicine, 2The Texas Tech Health Sciences Center Department of Surgery
Background: Coccidioidomycosis is a fungal infection endemic to the southwestern United States, Central America and South America. Coccidioides is ubiquitous in many of these endemic regions, with near 100% seroconversion in some communities. Two-thirds of these mycotic infections may be asymptomatic. The most common presentation of coccidioidomycosis consists of “flu-like” symptoms or pneumonia. Less than five percent of symptomatic cases progress to disseminated coccidioidomycosis which may involve any organ system. Very rarely infection may include the peritoneum. We report a case of coccidioidomycosis with peritoneal involvement in an immunocompetent individual.
Case: A 36-year-old male presented to the Emergency Department with progressive abdominal pain. He was seen and treated for pneumonia in the Emergency Department one week prior. The patient worked outdoors in Arizona and was otherwise healthy with a family history of malignancy and blood disorders. Fever, leukocytosis and ascites on computed tomography scan prompted a diagnostic laparoscopy which revealed peritoneal granulomas positive for Coccidioides. The patient was treated outpatient with Fluconazole.
Discussion: Since 1939 this is the 38th reported case of peritoneal coccidioidomycosis to our knowledge. The patient described in this case report was an otherwise healthy 36-year-old male; this is incongruent with many of the previously recorded cases which involved disseminated disease in immunocompromised patients. The patient’s family history of malignancy and blood disorders suggests a potential underlying genetic predisposition that could account for this abdominal presentation. Possible mutations include genes coding for the interleukin-12 β1 receptor and the signal transducer and activator of transcription 1 which have been implicated in increased coccidioidomycosis susceptibility. Peritoneal infection presents a unique challenge in diagnosis. In these cases coccidioidomycosis may not be suspected due to nonspecific symptoms and imaging, the infrequency of this extra-pulmonary manifestation and clinical characteristics that mimic the presentation of tuberculosis and malignancy. Abdominal infections have been misdiagnosed as appendicular abscesses, iliopsoas abscesses, adnexal abscesses and pancreatic masses. Consequently, the diagnosis of peritoneal coccidioidomycosis is often made after laparoscopic exploration of the abdomen and histopathology, as it was in this case report.
Conclusions: Coccidioidomycosis incidence is on the rise in endemic areas and it often falls on the surgeon to make the diagnosis in extra-pulmonary cases. The peritoneal subset of coccidioidomycosis should be considered in endemic areas when a young, otherwise healthy patient presents with abdominal pain. Failure to recognize the possibility of coccidioidomycosis may lead to unnecessary treatments and procedures.