Skin lesion of coccidioidomycosis

Definition

Skin lesions of coccidioidomycosis are skin symptoms of a fungal infection caused by Coccidioides immitis.

Causes

Coccidioidomycosis is a fungal infection most often found in the desert regions of the southwestern US, and in Central and South America. It is acquired by breathing in fungal particles from soil in these regions. The point of entry for this infection is the lung.

Up to one-half of affected individuals have mild or no symptoms. Immunosuppressed individuals, such as people with AIDS, cancer, or transplant recipients, are at higher risk of severe, widespread (disseminated) disease.

Skin lesions can occur in the early stages of coccidioidomycosis (during primary lung infection). They include erythema nodosum or erythema multiforme

After primary infection in the lungs, the fungus itself may spread to other tissues including the skin, and lead to various skin lesions including papules, nodules, and ulcers. These lesions contain fungus within them and are a manifestation of disseminated (widespread) fungal disease.

Symptoms

• Skin lesion of primary infection
  • Papular rash
  • Erythema nodosum
  • Erythema multiforme (target lesions)
• Skin lesion of disseminated disease: papule, pustule, nodule, or plaque
  • May ulcerate
  • Most frequently found on the face
  • May form abscesses

Exams and Tests

The diagnosis depends on the stage of infection (primary versus disseminated). Diagnosis may include skin biopsy to find the fungus in a culture if disseminated disease is suspected.

Treatment

The mainstay of treatment includes antifungal medications. Depending on the form or stage of disease, intravenous or oral forms of medications may be used. Antifungal agents commonly used include amphotericin B, itraconazole, ketoconazole, or fluconazole. People with disseminated disease and underlying immunosuppression may require long-term treatment.

Outlook (Prognosis)

The outcome varies with the stage and extent of infection, as well as the underlying immune system status of the individual. Disseminated disease has the highest mortality rate, particularly in immunosuppressed individuals.

Possible Complications

• Secondary bacterial skin infection
• Skin abscess
• Complications related to medications

When to Contact a Medical Professional

There are many types of skin lesions, and they can be hard to tell apart. Notify your medical provider if you develop skin lesions and suspect this condition, because you will need to be tested.

Chiller TM. Coccidioidomycosis. Infect Dis Clin North Am. 2003; 17(1): 41-57, viii.

Murray J, Nadel J. Textbook of Respiratory Medicine. 3rd ed. Philadelphia, Pa: WB Saunders; 2000.

Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. 5th ed. London, UK: Churchill Livingstone; 2000:2746-2755.

Galgiani JN, Ampel N, Blair JE, et al. Coccidioidomycosis. Clin Infect Dis. 2005;41:1217-23.