A Rare Case of Disseminated Coccidioidomycosis Presenting as an Intracardiac Mass | Annals of Internal Medicine: Clinical Cases
A 26-year-old immunocompetent male with a history of disseminated coccidioidomycosis presented with shortness of breath for 2 weeks. Computed tomography showed a right paratracheal mass that extended into and compressed the right ventricle. Transthoracic echocardiogram confirmed the presence of a large homogenous mass. Biopsy results revealed granulomatous inflammation with numerous organisms, consistent with Coccidioides. Despite treatment with antifungal therapy, the patient expired due to hemodynamic decline. Extrapulmonary involvement of Coccidioides is rare and is associated with significant morbidity and mortality. Even with completed treatment, the rate of relapse is high, necessitating regular follow up, drug resistance testing, and the monitoring of complement fixation titers.