{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T13:55:02Z","timestamp":1762005302000,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,2,26]]},"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:p>Coccidioidomycosis is a systemic fungal infection first described in 1892. More than 95% of annual cases occur in Arizona and California. It is an opportunistic infection (OI) transmitted via inhalation of airborne spores (arthroconidia) and rarely via percutaneous inoculation into a tissue or solid organ transplantation in patients who are immunocompromised and with HIV. With the advent of antiretroviral therapy (ART), the incidence of OIs has markedly reduced; however, OIs continue to occur, particularly in patients who present late for medical care or delay ART initiation. In rare cases, immunodeficient individuals may experience a paradoxical worsening or unmasking of OI symptoms, known as the immune reconstitution inflammatory syndrome (IRIS). We present a case of a 31-year-old man with disseminated coccidioidomycosis affecting the spleen, lymph nodes, lungs, bone marrow, and adrenals who developed IRIS after the initiation of ART.<\/jats:p>","DOI":"10.1136\/bcr-2018-227217","type":"journal-article","created":{"date-parts":[[2021,4,12]],"date-time":"2021-04-12T11:48:23Z","timestamp":1618228103000},"page":"e227217","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Disseminated coccidioidomycosis in a patient who is immunocompromised in the setting of immune reconstitution inflammatory syndrome"],"prefix":"10.1136","volume":"14","author":[{"given":"Hamid","family":"Yaqoob","sequence":"first","affiliation":[{"name":"Internal Medicine, Howard University Hospital, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Mohsin","family":"Munawar","sequence":"additional","affiliation":[{"name":"Internal Medicine, Howard University Hospital, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omer","family":"Salih","sequence":"additional","affiliation":[{"name":"Internal Medicine, Howard University Hospital, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anand","family":"Deonarine","sequence":"additional","affiliation":[{"name":"Internal Medicine, Howard University Hospital, Washington, DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,4,12]]},"reference":[{"key":"2025082722293833000_14.4.e227217.1","doi-asserted-by":"publisher","DOI":"10.1086\/496991"},{"key":"2025082722293833000_14.4.e227217.2","first-page":"217","article-title":"Increase in reported coccidioidomycosis--United States, 1998-2011","volume":"62","author":"","year":"2013","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025082722293833000_14.4.e227217.3","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.radcr.2016.11.017","article-title":"Disseminated coccidioidomycosis with multifocal musculoskeletal disease involvement","volume":"12","author":"McConnell","year":"2017","journal-title":"Radiol Case Rep"},{"key":"2025082722293833000_14.4.e227217.4","doi-asserted-by":"crossref","DOI":"10.3201\/eid2302.160505","article-title":"Risk factors for disseminated coccidioidomycosis, United States","volume":"23","author":"Odio","year":"2017","journal-title":"Emerg Infect Dis"},{"key":"2025082722293833000_14.4.e227217.5","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-130-4-199902160-00015"},{"key":"2025082722293833000_14.4.e227217.6","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1177\/2325957417729751","article-title":"Immune reconstitution inflammatory syndrome in patients with AIDS and disseminated coccidioidomycosis: a case series and review of the literature","volume":"16","author":"Mu","year":"2017","journal-title":"J Int Assoc Provid AIDS Care"},{"key":"2025082722293833000_14.4.e227217.7","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32833a3967"},{"key":"2025082722293833000_14.4.e227217.8","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1086\/630208","article-title":"Defining immune reconstitution inflammatory syndrome: evaluation of expert opinion versus 2 case definitions in a South African cohort","volume":"49","author":"Haddow","year":"2009","journal-title":"Clinical Infectious Diseases"},{"key":"2025082722293833000_14.4.e227217.9","doi-asserted-by":"publisher","DOI":"10.1053\/srin.2001.29301"},{"key":"2025082722293833000_14.4.e227217.10","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw360"},{"key":"2025082722293833000_14.4.e227217.11","doi-asserted-by":"publisher","DOI":"10.1080\/14787210.2017.1285697"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-227217","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T05:29:43Z","timestamp":1756358983000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-227217"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4]]},"references-count":11,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4,12]]},"published-print":{"date-parts":[[2021,4]]}},"alternative-id":["10.1136\/bcr-2018-227217"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-227217","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,4]]}}}