Images in Clinical Urology Coccidioidomycosis of the Genitourinary Tract: A Case Report and Discussion Arthi Satyanarayan, Stephen Klotz, Lucy Han, Richard Sobonya, and Tirdad T. Zangeneh Coccidioides species (Coccidioides immitis and Coccidioides posadasii) are dimorphic fungi endemic to the Southwestern United States. Initial infection ranges from asymptomatic to mild upper respiratory tract symptoms and may disseminate to other organs including the genitourinary tract. Genitourinary complaints may be the initial presenting signs and symptoms among a minority of patients. We report a case of genitourinary coccidioidomycosis and discussion of genitourinary disease with coccidioidomycosis. UROLOGY 84: e30ee31, 2014. 2014 Elsevier Inc.
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occidioides species (Coccidioides immitis and Coccidioides posadasii) are endemic to the Southwestern United States, notably Arizona and the San Joaquin Valley of California.1 In particular, these fungi have tropism for patients with darker skin (Filipino, African American, Hispanic), those with coexisting diabetes, and those who are immunosuppressed.1,2 Additional risk factors for Coccidioides infection in the genitourinary tract include indwelling urinary catheters, female gender, and hematologic cancers, though none of these are required for infection.2 Studies have also shown an association with increased infection in the summer when the previous summer had heavy rainfall.2 Infection may initially present as a mild upper respiratory infection or community-acquired pneumonia that may or may not disseminate via the hematogenous route from the primary pulmonary infection.1,2 The dissemination infection is defined as one or more destructive extrapulmonary lesions, which most commonly involve the skin, followed by meninges, bones, and joints. These types of lesions occur in about
C
occidioides species (Coccidioides immitis and Coccidioides posadasii) are endemic to the Southwestern United States, notably Arizona and the San Joaquin Valley of California.1 In particular, these fungi have tropism for patients with darker skin (Filipino, African American, Hispanic), those with coexisting diabetes, and those who are immunosuppressed.1,2 Additional risk factors for Coccidioides infection in the genitourinary tract include indwelling urinary catheters, female gender, and hematologic cancers, though none of these are required for infection.2 Studies have also shown an association with increased infection in the summer when the previous summer had heavy rainfall.2 Infection may initially present as a mild upper respiratory infection or community-acquired pneumonia that may or may not disseminate via the hematogenous route from the primary pulmonary infection.1,2 The dissemination infection is defined as one or more destructive extrapulmonary lesions, which most commonly involve the skin, followed by meninges, bones, and joints. These types of lesions occur in about
