{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T16:33:13Z","timestamp":1759336393875,"version":"3.44.0"},"reference-count":16,"publisher":"American Society for Microbiology","issue":"4","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["ASM Case Rep"],"published-print":{"date-parts":[[2025,7]]},"abstract":"ABSTRACT<\/jats:title>\n \n \n \n Background<\/jats:title>\n \n As\n Coccidioides<\/jats:italic>\n spp. are endemic in the southwestern United States, awareness of the risk factors for severe disease and dissemination is important to avoid delays in diagnosis and treatment. In addition to immunocompetent patients, individuals of certain ethnic backgrounds, especially African and Filipino ancestry, are at higher risk for dissemination. Diagnostic testing may be complicated by the lack of available invasive specimens for histopathologic examination and culture.\n <\/jats:p>\n <\/jats:sec>\n \n Case Summary<\/jats:title>\n \n A 29-year-old African American woman presented with a 6-year history of abdominal bloating and discomfort, which was previously diagnosed as endometriosis and possible irritable bowel syndrome. After multiple visits to primary care, urgent care, and emergency settings, she was referred for outpatient gynecology and gastrointestinal follow-up. Imaging revealed diffuse peritoneal nodules potentially concerning for malignancy, and biopsies revealed\n Coccidioides<\/jats:italic>\n spp. spherules on the frozen section. Routine bacterial and fungal cultures from the biopsied nodules grew\n Coccidioides immitis\/posadasii<\/jats:italic>\n . The patient was placed on fluconazole with rapid symptom resolution and was maintained on fluconazole at a 2-year follow-up.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The case presented highlights a reasonably common occurrence in endemic regions\u2014the delayed diagnosis of coccidioidomycosis due to the lack of consideration as the etiology of the patient\u2019s symptoms. This patient was at risk for dissemination due to her ethnicity, and while the differential for her presenting symptoms was broad, coccidioidomycosis should have been considered. In immunocompetent patients, like the case presented, serologic testing should be pursued, as severe or disseminated cases typically have positive IgG responses.<\/jats:p>\n <\/jats:sec>\n <\/jats:sec>","DOI":"10.1128\/asmcr.00098-24","type":"journal-article","created":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T09:00:51Z","timestamp":1744362051000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":2,"title":["A case of delayed diagnosis of disseminated coccidioidomycosis highlights opportunities for improved awareness"],"prefix":"10.1128","volume":"1","author":[{"given":"Mylan","family":"Blomquist","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, Mayo Clinic","place":["Phoenix, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob","family":"Karsten","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, Mayo Clinic","place":["Phoenix, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brandon","family":"Larsen","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, Mayo Clinic","place":["Phoenix, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6014-4570","authenticated-orcid":true,"given":"Erin","family":"Graf","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, Mayo Clinic","place":["Phoenix, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"235","reference":[{"doi-asserted-by":"publisher","key":"e_1_3_1_2_2","DOI":"10.1029\/2019GH000209"},{"doi-asserted-by":"publisher","key":"e_1_3_1_3_2","DOI":"10.1093\/ofid\/ofae461"},{"doi-asserted-by":"publisher","key":"e_1_3_1_4_2","DOI":"10.3201\/eid1407.070832"},{"doi-asserted-by":"publisher","key":"e_1_3_1_5_2","DOI":"10.1093\/cid\/ciw360"},{"doi-asserted-by":"publisher","key":"e_1_3_1_6_2","DOI":"10.3201\/eid2302.160505"},{"doi-asserted-by":"publisher","key":"e_1_3_1_7_2","DOI":"10.1128\/JCM.01776-06"},{"doi-asserted-by":"publisher","key":"e_1_3_1_8_2","DOI":"10.4065\/mcp.2010.0423"},{"doi-asserted-by":"publisher","key":"e_1_3_1_9_2","DOI":"10.3201\/eid2509.190019"},{"doi-asserted-by":"publisher","key":"e_1_3_1_10_2","DOI":"10.1172\/jci.insight.159491"},{"doi-asserted-by":"publisher","key":"e_1_3_1_11_2","DOI":"10.1093\/ofid\/ofac017"},{"key":"e_1_3_1_12_2","volume-title":"Biosafety in microbiological and biomedical laboratories","author":"Chosewood LC","year":"2009","unstructured":"Chosewood LC, Wilson DE, Centers for Disease Control and Prevention (U.S.), National Institutes of Health (U.S.). 2009. Biosafety in microbiological and biomedical laboratories. 5th ed. U.S. Dept. of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institutes of Health, Washington, D.C.","edition":"5"},{"doi-asserted-by":"publisher","key":"e_1_3_1_13_2","DOI":"10.1128\/AAC.02634-16"},{"doi-asserted-by":"publisher","key":"e_1_3_1_14_2","DOI":"10.1093\/ofid\/ofab444"},{"doi-asserted-by":"publisher","key":"e_1_3_1_15_2","DOI":"10.1093\/cid\/civ585"},{"doi-asserted-by":"publisher","key":"e_1_3_1_16_2","DOI":"10.1128\/CMR.3.3.247"},{"unstructured":"Centers for Medicare and Medicaid Services. 2025. Clinical laboratory fee schedule 25CLABQ1. Available from: https:\/\/www.cms.gov\/medicare\/payment\/fee-schedules\/clinical-laboratory-fee-schedule-clfs\/files. Retrieved 23 Jan 2025.","key":"e_1_3_1_17_2"}],"container-title":["ASM Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/asmcr.00098-24","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/asmcr.00098-24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T17:29:24Z","timestamp":1757438964000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/asmcr.00098-24"}},"subtitle":[],"editor":[{"given":"Ritu","family":"Banerjee","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":16,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1128\/asmcr.00098-24"],"URL":"https:\/\/doi.org\/10.1128\/asmcr.00098-24","relation":{},"ISSN":["2996-2684"],"issn-type":[{"type":"electronic","value":"2996-2684"}],"subject":[],"published":{"date-parts":[[2025,7]]},"assertion":[{"value":"2024-11-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e00098-24"}}