Coccidioides immitisCervical Lymphadenitis Complicated by Esophageal Fistula

Abstract

Coccidioidomycosis (valley fever) is caused by the dimorphic fungiCoccidioides immitisorCoccidioides posadasii. Most infections are asymptomatic or result in self-limited pneumonia; extrapulmonary dissemination via either hematogenous or lymphatic spread is rare. Here, we present a case of cervicalC. immitislymphadenitis that resulted in fistula formation to the esophagus via mediastinal extension. This case highlights a very unusual extrapulmonary manifestation of coccidioidomycosis, the difficulty in diagnosing coccidioidal infection when it is not suspected, and the importance of obtaining a thorough exposure history to assist with diagnosis.