Female genital coccidioidomycosis (FGC), Addison's disease and sigmoid loop abscess due to Coccidioides immites; Case report and review of literatureon FGC

We describe a woman with unusual complications of infection with Coccidioid es immitis - infection of the genital tract and adrenal insufficiency. The patient also had intestinal coccidioidomycosis (cocci) in conjunction with presumed pulmonary, and asymptomatic central nervous system cocci. To our k nowledge, concurrent FGC, intestinal and adrenal cocci have not been report ed previously. A MEDLINE review from 1966-1997 revealed only 1 case of adre nal insufficiency due to cocci. FGC is rare; we identified 12 reported case s since 1929. No combination of investigations or clinical features is sens itive enough to predict FGC. Diagnosis is usually made after microscopy of surgical specimens. FGC presents either as tubo-ovarian disease or endometr itis. Treatment generally involves surgical excision and antifungal agents. We hypothesize that an initial trial of antifungals may obviate the need f or surgery.