Coccidioidomicosis diseminada, diagnóstico a partir de una lesión cutánea.

BACKGROUND: Coccidioides spp infection (C. immitis and C. posadasii) is an endemic disease from south of United States and north of Mexico, but it is also present in other areas of central and south of America. It can be classified according to its clinical presentation in: asymptomatic, pulmonary/pleural, cutaneous and disseminated. CLINICAL CASE: A 30 year-old male patient whom started with disseminated skin lesions accompanied with fever, lymphadenopathy and subsequently neurological manifestations (headache and syncope). A skin and ganglionar biopsy was performed, where Coccidioides sp was identified, in cerebrospinal fluid hypoglycorrhachia and hyperproteinorrachia were found. A cerebral magnetic resonance imaging test with gadolinium contrast evidenced findings compatible with meningitis. The diagnosis of disseminated coccidioidomycosis was made, and treatment with amphotericin B was started with clinical improvement and subsequent discharge with fluconazole. CONCLUSIONS: Disseminated coccidioidomycosis has been described usually in immunocompromised patients (elderly, pregnancy, HIV, etc.). None of these were present in our patient, therefore it is important that endemic regions with a compatible clinical picture form part of the clinical suspicion. [ABSTRACT FROM AUTHOR]