A Case of Disseminated Coccidioidomycosis Involving Lung and Skin in Patient with Diabetes Mellitus and Iatrogenic Cushings Syndrome

Coccidioidomycosis is caused by a dimorphous fungus, Coccidioides, which consists of two species, C. immitis and C. posadasii. Although these organisms are genetically distinct and do not exchange DNA, they appear identical phenotypically and the disease or immune response to the organisms is also identical. Coccidioides grows as a mycelium in the soil and is mainly found in Southwestern United States, northwestern Mexico, and Argentina. An infection usually results from inhaling the spores of the fungu s in an endemic area. Patients with a localized infection and no risk factors for complications often require o nly a periodic reassessment to demonstrate the resolution of the self-limited process. However, patients with extensive spread of inf ection or high risk of complications as a result of immunosuppression or other preexis ting factors require a variety of treatment strategies such as antifungal therapy, surgical debridement, or both. Korea is not endemic area of a coccidioidomycosis. We report a case of disseminated coccidioidomycosis involving the lung and skin, which was detected incidentally after sunbur n in a 69 year-old Korean male with diabetes mellitus and iatrogenic Cushings syndrome, with a review of the relevant literature. (Tuberc Respir Dis 2005; 58: 399-403)Key words : Coccidioidomycosis, Sunburn, Diabetes mellitus, Cushings syn dromeAddress for correspondence : In-Gyu Hyun, M.D.Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, 94-200 Yeoungdeungpo-Dong, Yeoungdeungpo-Gu, Seoul, 150-020, KoreaPhone : 02-2639-5001 Fax : 02-2677-9756E-mail : ighyun@hallym.ac.krReceived : Jan. 26. 2005Accepted : Mar. 30. 2005