Subclinical Dissemination of Coccidioidomycosis in a Liver Transplant Recipient

Coccidioidomycosis is common in the southwestern United States, northern Mexico, and areas of South America. Coccidioides immitis and Coccidioides posadasii form arthroconidia that, if inhaled, can cause respiratory infection. Rarely, the organism disseminates throughout the body, causing disease in bones, lymph nodes, skin, joints, and brain in most severe cases. Certain populations are at higher risk for dissemination, including persons with compromised cellular immunity. This group includes patients with human immunodeficiency virus, patients undergoing immunosuppression for rheumatologic disorders, and patients receiving antirejection therapy after organ transplant. For patients undergoing a solid organ transplant in endemic areas, screening for past or present coccidioidal disease is completed pretransplantation. Those with known disease are given triazole therapy to prevent reactivation of disease posttransplantation. Usually, transplantation is postponed if the disease is active. We present a patient with known, active coccidioidomycosis who underwent successful liver transplant and later had subclinical posttransplantation peritoneal dissemination.