The fungus Coccidioides immitis ultimately infects most lifelong residents of highly endemic regions.1,2 Progressive primary infection occurs in probably less than 0.2% of infected individuals,3 is more frequent among persons with dark skin, and often is associated with a rising complement fixation titer and loss of prior sensitivity to intradermal coccidioidin.4-7 Considering the large number of people infected with this fungus, reports of disseminated coccidioidomycosis associated with corticosteroid therapy are infrequent. In contrast to other fungi, including Candida, Aspergillus, Mucor, and Cryptococcus, Coccidioides is not generally considered an opportunistic organism.2,8-11 This report concerns a patient with disseminated coccidioidomycosis complicating primary biliary cirrhosis. The opportunistic potential of C immitis is discussed with consideration of the pertinent literature.
A 56-year-old white woman was admitted to William Beaumont General Hospital Aug 30, 1965, for management of severe hepatic cirrhosis. She was well until 17 years of age