Disseminated coccidioidomycosis masquerading as recurrent lymphoma

Description

Infection with Coccidioides immitis, a soil-dwelling fungus endemic to the American Southwest, may have protean manifestations in immunocompromised patients who reside in1 2 or who have travelled to3 that region. We report a patient whose abnormal PET/CT scan raised concern for recurrent lymphoma but instead was due to disseminated coccidioidomycosis.

A 62-year-old woman was diagnosed with ileocaecal marginal zone lymphoma (MZL) after presenting with iron-deficiency anaemia and faecal occult blood. Ten years earlier, she underwent allogeneic haematopoietic cell transplantation for acute myeloid leukaemia (AML). She had recurrent cutaneous chronic graft-versus-host-disease (CGVHD); 50 months before the diagnosis of MZL, she completed a 9-month course of prednisone (50 mg every other day) and did not receive any further corticosteroid therapy. At the time of diagnosis of MZL, the patient was receiving twice-monthly extracorporeal photopheresis (ECP), which had been initiated 1 year earlier for the most...

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