2017 Resarch Forum

IM: C-1

Applicant & Principal Investigator: Ali Ammar MD

Coccidioidomycosis disseminated to the mastoid bone Ali Ammar MD, Greti Petersen MD, Caitlyn Duffin MS IV, Arash Heidari MD

INTRODUCTION Coccidioidomycosis is a fungal pathogen that has a history of repeated infections primarily in Southwestern United States and Northern Mexico. Manifestations of coccidioidomycosis infections can range from pneumonia to organ and tissue dissemination. PURPOSE To present a case of coccidioidomycosis disseminated to the mastoid bone. DISCUSSION This is a 27-year old Hispanic male with type I diabetes mellitus and disseminated coccidioidomycosis involving the lungs and left knee. He presented to the emergency roommultiple times over several months complaining of unilateral hearing loss, ear pain and purulent otorrhea leading to resection of the left mastoid process. Mastoid bone biopsy identified epithelioid granulomas enclosing spherules with endospores, thus establishing the diagnosis of disseminated coccidioidomycosis. Post-operatively, the patient had multiple readmissions after presenting with subjective fevers, multiple episodes of emesis, worsening cachexia and grand mal seizures. This is an extremely unusual because there is no such prior case documented in an adult in the literature. CONCLUSION

Consider disseminated coccidioidomycosis in a patient with unexplained hearing loss and pain.