{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:04:46Z","timestamp":1756339486712,"version":"3.44.0"},"reference-count":18,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,4,1]]},"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:p>A middle-aged woman was hospitalised for generalised, painful skin lesions 6 weeks after a successful double-lung transplant. She had end-stage lung disease associated with chronic obstructive pulmonary disease due to alpha-1 antitrypsin deficiency, and she had been treated with itraconazole for 16 months because of lung infection associated with <jats:italic>Malbranchea<\/jats:italic> spp. Results of a skin biopsy of the initial lesion on her arm showed non-specific dermal inflammation, presumably due to reactivation of the <jats:italic>Malbranchea<\/jats:italic> spp infection. Follow-up cervical lymph node biopsy and culture showed <jats:italic>Coccidioides posadasii<\/jats:italic>\/<jats:italic>C. immitis<\/jats:italic>. A detailed review of her travel history showed a 4-month stay in Arizona as a teenager that she barely remembered. <jats:italic>Coccidioides<\/jats:italic> spp were likely misidentified as <jats:italic>Malbranchea<\/jats:italic> spp owing to similar morphological characteristics. Dosages of immunosuppressive medications were reduced, and antifungal therapy was changed to posaconazole. Her skin lesions resolved.<\/jats:p>","DOI":"10.1136\/bcr-2019-230888","type":"journal-article","created":{"date-parts":[[2020,4,17]],"date-time":"2020-04-17T07:00:55Z","timestamp":1587106855000},"page":"e230888","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["<i>Coccidioides<\/i> in lung transplant: case report"],"prefix":"10.1136","volume":"13","author":[{"given":"Mark Anthony","family":"Diaz","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Luisa","family":"Bayo","sequence":"additional","affiliation":[{"name":"University of Navarra, Pamplona, Navarra, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco","family":"Alvarez","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salvador","family":"Alvarez","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,4,16]]},"reference":[{"key":"2025082708150607000_13.4.e230888.1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofw086"},{"key":"2025082708150607000_13.4.e230888.2","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1055\/s-0035-1562900","article-title":"Coccidioidomycosis: recent updates","volume":"36","author":"Twarog","year":"2015","journal-title":"Semin Respir Crit Care Med"},{"key":"2025082708150607000_13.4.e230888.3","first-page":"494","article-title":"Disseminated coccidioidomycosis: a case report from the United Kingdom","volume":"2","author":"Al-Daraji","year":"2009","journal-title":"Int J Clin Exp Pathol"},{"key":"2025082708150607000_13.4.e230888.4","doi-asserted-by":"publisher","DOI":"10.4065\/83.3.343"},{"key":"2025082708150607000_13.4.e230888.5","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.ccm.2017.04.005","article-title":"Diagnosis and management of coccidioidomycosis","volume":"38","author":"Gabe","year":"2017","journal-title":"Clin Chest Med"},{"key":"2025082708150607000_13.4.e230888.6","doi-asserted-by":"crossref","first-page":"71","DOI":"10.6002\/ect.2012.0254","article-title":"Pulmonary coccidioidomycosis after a renal transplant in a nonendemic region","volume":"12","author":"Tepeoglu","year":"2014","journal-title":"Exp Clin Transplant"},{"key":"2025082708150607000_13.4.e230888.7","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1982.00340160069017"},{"key":"2025082708150607000_13.4.e230888.8","doi-asserted-by":"publisher","DOI":"10.1086\/323463"},{"key":"2025082708150607000_13.4.e230888.9","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e31822e6e9a"},{"key":"2025082708150607000_13.4.e230888.10","doi-asserted-by":"crossref","first-page":"S56","DOI":"10.1093\/mmy\/myy019","article-title":"Coccidioidomycosis in selected immunosuppressed hosts","volume":"57","author":"Blair","year":"2019","journal-title":"Med Mycol"},{"key":"2025082708150607000_13.4.e230888.11","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2012.04100.x"},{"key":"2025082708150607000_13.4.e230888.12","doi-asserted-by":"publisher","DOI":"10.1007\/s11046-006-0062-5"},{"key":"2025082708150607000_13.4.e230888.13","doi-asserted-by":"crossref","first-page":"3562","DOI":"10.1111\/ajt.13950","article-title":"Coccidioidomycosis transmission through organ transplantation: a report of the OPTN AD hoc disease transmission Advisory Committee","volume":"16","author":"Kusne","year":"2016","journal-title":"Am J Transplant"},{"key":"2025082708150607000_13.4.e230888.14","doi-asserted-by":"publisher","DOI":"10.1086\/519937"},{"key":"2025082708150607000_13.4.e230888.15","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0b013e3283073828"},{"key":"2025082708150607000_13.4.e230888.16","doi-asserted-by":"crossref","unstructured":"Sciortino CV . 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