69 Disseminated Coccidioidomycosis in Nine Patients Diagnosed by Cytology and Culture

Introduction/Objective Coccidioidomycosis is typically a self-limited respiratory infection which may become disseminated especially in immunocompromised individuals. We diagnosed disseminated coccidioidomycosis using cytology in nine patients. Methods/Case Report We reviewed the last 20 years of cytology cases for Coccidioidomycosis diagnosed by cytology including demographics, underlying conditions, infection spread, cultures and clinical outcomes. Results We found 9 patients (7 males, 2 females) aged 27 to 68 years, with diverse ethnic backgrounds. There were 2 fine needle aspirations (FNAs) of lung, 2 mediastinal lymph node FNAs, 4 bronchial alveolar lavages (BAL) and one breast mass FNA. Fungal organisms {spherules (100 µm) with endospores (up to 5 µm)} were seen. Four patients had underlying immunosuppression. Cultures were positive in eight patients. Four patients had traveled outside of Texas. Conclusion Cytology is an important tool for diagnosing unsuspected potentially lethal disseminated coccidioidomycosis by morphologic identification. It complements culture and serological testing as cultures often take several days. Importantly, it must be considered in all patients since 5 of our patients had no immunosuppression. Cytology offers rapid identification to further guide patient management, allows early therapeutic intervention, and facilitates quick initiation of infection control measures.