Erythema Nodosum in Pregnant Patients with Coccidioidomycosis

Pregnant patients with coccidioidomycosis develop dissemination and serious disease more frequently than do the general population. To assist in prognosis and management, we analyzed the significance of erythema nodosum in pregnant patients with coccidioidomycosis. Sixty-one pregnant patients (mean age +/- SD, 26.4 +/- 6.3 years) were evaluated. Seventy percent of the patients were Hispanic; 15%, African American; 13%, Caucasian; and 2%, unknown race. Of the 30 patients (49%) who developed erythema nodosum, 0 had disseminated disease (P = .001), 1 (3%) with pulmonary involvement required therapy for > 1 year, and 29 (97%) recovered (P = .0008). Of the 31 patients (51%) without erythema nodosum, 11 (35%) had disseminated disease, 12 (39%) required therapy for > 1 year, 17 (55%) recovered, 1 (3%) died, and 1 (3%) had an outcome that was unknown. Erythema nodosum appears to be a salient marker of a positive outcome for pregnant patients, more so than for the general population.