Figure Descriptions: (1) Coccidioidomycosis and incidence ra | Figure 1

Journal of Investigative Medicine

Figure Descriptions:

  1. Coccidioidomycosis and incidence rates by year of estimated illness onset, California, 2001 to 2018.
  2. Chest X-ray at presentation demonstrating cavitary lesion of right upper lobe.
  3. (a and b) Computed tomography (CT) of the chest showed increased ground-glass opacities in bilateral lobes. These were not seen in previous CT chest.

Case Description:

In the middle of a pandemic, patients with cough and fever are thought to have SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2). It should be remembered that in the desert southwest of the United States, we have an ongoing epidemic of coccidioidomycosis (CM). There are additionally many other respiratory illnesses that could be confused with CoV-2 or overlooked. This is a case report of CoV-2 engrafted on chronic cavitary pulmonary CM. In a time where the coronavirus pandemic is becoming rampant, we demonstrate the case of a coinfection with cavitary pulmonary CM. In this case, the importance of detection of the coronavirus and treatment of the coinfection is explored.

Read the full case report: "The Coincidence of 2 Epidemics, Coccidioidomycosis and SARS-CoV-2"

The CT images demonstrate multiple ground-glass opacities, some of them with reticulation. There are small foci of consolidation involving all pulmonary lobes, with predominant distribution in the posterior and peripheral parts of the lungs, especially in the lower lobes, where most of the opacities spare the immediate subpleural parts of the parenchyma (subpleural sparing). With thanks to Wenzhou Medical University, China for sharing this case, and to Dr. Rodrigo Caruso Chate, a chest radiologist in Brazil, for the CT interpretation. Case provided by Raioss.

The patient’s CT reveals multiple ground-glass opacities, most of them with reticulation, and some associated with small foci of consolidation with air bronchograms involving all pulmonary lobes. The distribution is predominantly in the posterior and peripheral parts of the lungs, mainly in the lower lobes, where there is more extensive involvement of the parenchyma.

The coronavirus disease 2019 (COVID-19) pandemic revealed a myriad of postinfectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequelae, many of which remain poorly understood. We describe a rare presentation of a patient developing 2 simultaneous COVID-19 sequelae: transverse myelitis and acquired von Willebrand syndrome (AVWS).

Additional Cases:

1. A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.

2. A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back with multiple small vesicles.

3. A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days with pustules and papules.