PRIMARY DIAGNOSIS OF DISSEMINATED COCCIDIOIDOMYCOSIS BY FINE-NEEDLE ASPIRATION OF A NECK MASS - A CASE-REPORT

Coccidioinomycosis is a pulmonary fungal infection endemic to the sout hwestern United States and northern Mexico. Disseminnted coccidioidomy cosis occurs in 0.1-0.5% of cases and is a life-threatening condition. We report a case of disseminated coccidioidiomycosis in an immunocomp etent black male with cutaneous lesions, a flocculent neck mass, bilat eral hilar adenopathy, persistent fever, night sweats and malaise. The clinical suspicion was lymphoma with cutaneous involvement. Fine need le aspiration (FNA) of the neck mass provided the primary diagnosis of coccidioidomycosis. It was confirmed by culture of FNA-obtained fluid and a subsequent biopsy of a cutaneous lesion. As shown in this case, FNA of soft tissue masses may provide rapid identification of tire re sponsible organism and allow early initiation of therapy for this pote ntially life-threatening infection.