Disseminated Coccidioidomycosis Following COVID-19 Mimicking Metastatic Thoracic Relapse of Well-Differentiated Liposarcoma: A Case Report
Introduction: COVID-19 is associated with immune dysregulation which may increase susceptibility to atypical infectious diseases, particularly in the vulnerable cancer patient population. Coccidioidomycosis is an endemic fungal infection which presents with mild-to-moderate pneumonia in most cases.C...
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| Format: | Article |
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Frontiers Media S.A.
2021-09-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2021.715939/full |
| _version_ | 1819136775331774464 |
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| author | Elise F. Nassif Nolan Maloney Anthony P. Conley Emily Z. Keung |
| author_facet | Elise F. Nassif Nolan Maloney Anthony P. Conley Emily Z. Keung |
| author_sort | Elise F. Nassif |
| collection | DOAJ |
| description | Introduction: COVID-19 is associated with immune dysregulation which may increase susceptibility to atypical infectious diseases, particularly in the vulnerable cancer patient population. Coccidioidomycosis is an endemic fungal infection which presents with mild-to-moderate pneumonia in most cases.Case Presentation: The presented case is a 67-year-old woman living in the southwestern United States who is under close observation for well-differentiated liposarcoma of the abdominal wall. She presented with persistent cough and fatigue following COVID-19 infection. Imaging revealed new pulmonary nodules, a chest wall mass and bone lesions. The imaging appearance of these lesions was consistent with metastatic disease, although distant metastasis is not typical in well-differentiated liposarcoma. Biopsy of the chest wall mass revealed granulomatous fungal infection and serology was positive for coccidioidomycosis. At the time of diagnosis, the patient was lymphopenic, possibly a sequela of recent COVID-19 infection and which may have contributed to the development of her atypical disseminated form of coccidioidomycosis. Patient was treated with fluconazole for the coccidioidomycosis and continued observation for mild progression of the liposarcoma. On follow-up imaging, the chest wall mass and lung nodules have decreased in size and the patient remains on antifungal treatment. There has been no further increase in the liposarcoma mass.Conclusion: COVID-19 may be associated with increased risk of atypical forms of infectious diseases in cancer patients, which physicians should be aware of before giving systemic treatments for cancer. In endemic regions, co-infection by coccidioidomycosis should be suspected in cases of persistent symptoms after COVID-19 infection. |
| first_indexed | 2024-12-22T10:40:20Z |
| format | Article |
| id | doaj.art-a8aa068c42814c75a5c0c05ca0d9281c |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-22T10:40:20Z |
| publishDate | 2021-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-a8aa068c42814c75a5c0c05ca0d9281c2022-12-21T18:29:03ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-09-01810.3389/fmed.2021.715939715939Disseminated Coccidioidomycosis Following COVID-19 Mimicking Metastatic Thoracic Relapse of Well-Differentiated Liposarcoma: A Case ReportElise F. Nassif0Nolan Maloney1Anthony P. Conley2Emily Z. Keung3Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United StatesIntroduction: COVID-19 is associated with immune dysregulation which may increase susceptibility to atypical infectious diseases, particularly in the vulnerable cancer patient population. Coccidioidomycosis is an endemic fungal infection which presents with mild-to-moderate pneumonia in most cases.Case Presentation: The presented case is a 67-year-old woman living in the southwestern United States who is under close observation for well-differentiated liposarcoma of the abdominal wall. She presented with persistent cough and fatigue following COVID-19 infection. Imaging revealed new pulmonary nodules, a chest wall mass and bone lesions. The imaging appearance of these lesions was consistent with metastatic disease, although distant metastasis is not typical in well-differentiated liposarcoma. Biopsy of the chest wall mass revealed granulomatous fungal infection and serology was positive for coccidioidomycosis. At the time of diagnosis, the patient was lymphopenic, possibly a sequela of recent COVID-19 infection and which may have contributed to the development of her atypical disseminated form of coccidioidomycosis. Patient was treated with fluconazole for the coccidioidomycosis and continued observation for mild progression of the liposarcoma. On follow-up imaging, the chest wall mass and lung nodules have decreased in size and the patient remains on antifungal treatment. There has been no further increase in the liposarcoma mass.Conclusion: COVID-19 may be associated with increased risk of atypical forms of infectious diseases in cancer patients, which physicians should be aware of before giving systemic treatments for cancer. In endemic regions, co-infection by coccidioidomycosis should be suspected in cases of persistent symptoms after COVID-19 infection.https://www.frontiersin.org/articles/10.3389/fmed.2021.715939/fullCOVID 19coccidioidomycosislymphopeniametastasissarcoma |
| spellingShingle | Elise F. Nassif Nolan Maloney Anthony P. Conley Emily Z. Keung Disseminated Coccidioidomycosis Following COVID-19 Mimicking Metastatic Thoracic Relapse of Well-Differentiated Liposarcoma: A Case Report Frontiers in Medicine COVID 19 coccidioidomycosis lymphopenia metastasis sarcoma |
| title | Disseminated Coccidioidomycosis Following COVID-19 Mimicking Metastatic Thoracic Relapse of Well-Differentiated Liposarcoma: A Case Report |
| title_full | Disseminated Coccidioidomycosis Following COVID-19 Mimicking Metastatic Thoracic Relapse of Well-Differentiated Liposarcoma: A Case Report |
| title_fullStr | Disseminated Coccidioidomycosis Following COVID-19 Mimicking Metastatic Thoracic Relapse of Well-Differentiated Liposarcoma: A Case Report |
| title_full_unstemmed | Disseminated Coccidioidomycosis Following COVID-19 Mimicking Metastatic Thoracic Relapse of Well-Differentiated Liposarcoma: A Case Report |
| title_short | Disseminated Coccidioidomycosis Following COVID-19 Mimicking Metastatic Thoracic Relapse of Well-Differentiated Liposarcoma: A Case Report |
| title_sort | disseminated coccidioidomycosis following covid 19 mimicking metastatic thoracic relapse of well differentiated liposarcoma a case report |
| topic | COVID 19 coccidioidomycosis lymphopenia metastasis sarcoma |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2021.715939/full |
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