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Case Reports in Infectious Diseases
Volume 2016, Article ID 8715405, 4 pages
http://dx.doi.org/10.1155/2016/8715405
Case Report

Coccidioides immitis Cervical Lymphadenitis Complicated by Esophageal Fistula

1Department of Internal Medicine, Oregon Health and Science University, Portland, OR 97239, USA
2Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR 97239, USA
3Division of Infectious Diseases, Oregon Health and Science University, Portland, OR 97239, USA

Received 17 February 2016; Accepted 8 May 2016

Academic Editor: Sinésio Talhari

Copyright © 2016 Michael Loudin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Coccidioidomycosis (valley fever) is caused by the dimorphic fungi Coccidioides immitis or Coccidioides 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 cervical C. immitis lymphadenitis 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.