Chronic interstitial granulomatous dermatitis in coccidioidomycosis. (3rd February 2016)

• Record Type: Journal Article
• Authors: Mangold, A.R.; DiCaudo, D.J.; Blair, J.E.; Sekulic, A.
• Is Part Of: British journal of dermatology. Volume 174:Number 4(2016)
• Page Start: 881
• Page End: 884
• Publication Date: 2016-02-03
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.14295
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: Coccidioides species are soil‐dwelling fungi endemic to the Southwest U.S.A., especially Arizona and California and Northern Mexico. The cutaneous findings of coccidioidomycosis have a wide range of pathology, which includes organism‐specific and reactive processes. Interstitial granulomatous dermatitis (IGD), a granuloma annulare‐like reaction, has been described, in a limited form, in association with acute pulmonary coccidioidomycosis. We present a case of chronic, widespread IGD spanning over 9 years in association with an active coccidioidomycosis infection. Similar clinical and histopathological features have been described in association with drug reactions, connective tissue diseases, systemic vasculitis, lymphomas, other infectious diseases and inflammatory bowel disease. Our patient's dramatic presentation and chronic course expands upon the clinical spectrum of IGD occurring in association with pulmonary coccidioidomycosis. While IGD in association with coccidioidomycosis is rare, both dermatologists and general practitioners see IGD reactions, and our case highlights the importance of identifying the underlying driver. Abstract : What's already known about this topic? Coccidioidomycosis is known to produce an interstitial granulomatous reaction. Interstitial granulomatous dermatitis can occur as an acute manifestation of coccidioidomycosis and commonly involves limited areas of the body. What does this study add? Interstitial granulomatous dermatitis secondary to coccidioidomycosis may be chronic and widespread. Recurrent or persistent reactive manifestations of coccidioidomycosis may indicate active disease. Indolent infections, such as coccidioidomycosis, should be considered in the differential diagnosis of chronic interstitial granulomatous dermatitis.