Coccidioides Infection Mimicking Metastatic Lung Cancer

Coccidioides is a fungus common in the arid Southwestern United States which can cause severe and sometimes life-threatening infections of the lung and other parts of the body. A case report was made of a 42-year-old male west Texas farmer who presented with a 2-month history of shortness of breath, fever, fatigue, night sweats, and weight loss (1).

A CT scan of the lung found numerous nodules suggestive of lung cancer. He also had a 1.2 cm skin nodule above his life eye suggestive of metastatic cancer.

Earlier treatment with the anti-bacterial drugs Bactrim and ciprofloxacin were ineffective. Eventually, the eyebrow culture identified Coccidioides fungi and no bacteria. He was treated with the anti-fungal drug fluconazole with good response.

Biopsies of the lungs and skin are often useful to detect fungal growth which may mimic cancer. An earlier review reported that fungal infections of a number of fungi including Paracoccidioides, Histoplasma, Cryptococcus, Coccidioidies, Aspergillus, Rhizopus, Mucor, and Cunninghamella can cause severe lung infections which are frequently initially misdiagnosed as lung cancer (2).

References / Sources

1. Saenz-Ibarra B, Prieto VG, Torres-Cabala CA, Huen A, Nagarajan P, Tetzlaff MT, et al. Coccidioidomycosis Involving Lungs and Skin: A Mimicker of Metastatic Disease. The American Journal of dermatopathology. 2017.

2. Gazzoni FF, Severo LC, Marchiori E, Irion KL, Guimaraes MD, Godoy MC, et al. Fungal diseases mimicking primary lung cancer: radiologic-pathologic correlation. Mycoses. 2014;57(4):197-208.