Primary cutaneous coccidioidomycosis

Primary cutaneous coccidioidomycosis is a rare form of coccidioidomycosis, a fungal infection caused by the Coccidioides species. This form of the disease is characterized by skin lesions that occur following direct inoculation of the fungus into the skin, without any evidence of pulmonary or systemic involvement.

Etiology

Primary cutaneous coccidioidomycosis is caused by two species of fungi, Coccidioides immitis and Coccidioides posadasii. These fungi are endemic to the southwestern United States, northern Mexico, and parts of Central and South America. They reside in the soil and are released into the air when the soil is disturbed, leading to inhalation and potential infection.

Clinical Presentation

The disease typically presents as a solitary skin lesion at the site of inoculation. The lesion may initially appear as a small, erythematous papule that gradually enlarges and may ulcerate. Over time, the lesion may develop a verrucous or nodular appearance. The lesion is often accompanied by regional lymphadenopathy.

Diagnosis

Diagnosis of primary cutaneous coccidioidomycosis is typically made through a combination of clinical presentation, histopathological examination of a skin biopsy, and culture of the organism. The histopathology often reveals granulomatous inflammation with multinucleated giant cells and spherules filled with endospores, characteristic of Coccidioides infection.

Treatment

Treatment typically involves antifungal medications, such as fluconazole or itraconazole. In severe cases, or in individuals with compromised immune systems, amphotericin B may be used.

Epidemiology

Primary cutaneous coccidioidomycosis is a rare form of coccidioidomycosis. It is most commonly seen in individuals who live in or have traveled to endemic areas and have had direct skin contact with the soil or dust.

See Also

• Coccidioidomycosis
• Coccidioides immitis
• Coccidioides posadasii