PMC5465799_01
CT of the abdomen and pelvis of the patient on admission. The abdominal image (a) shows mesenteric lymphadenopathy. The pelvic image (b) shows terminal ileum thickening suggestive of a possible mass. The CT report suggested possible neoplasm. However, after further studies, we know these changes occurred due to coccidioidomycosis infection.
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Computed tomography (CT) scan of chest and abdomen without contrast was obtained and showed bilateral pleural effusions, diffuse mesenteric lymphadenopathy, mesenteric edema, minimal ascites, diffuse ill-defined omental hyperdensities, and regional lymphadenopathy suspicious for carcinomatosis peritonei (Fig. 1).
Endoscopic images of the abnormal mucosa noted in our patient. a Erythematous swollen ileocecal valve, denoted by an asterisk. b Inflammatory nodular mucosa in the upper half of terminal ileum, denoted by an arrow. This contrasts with the normal mucosa noted in the lower half of the same image.
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Colonoscopy showed evidence of terminal ileitis along with submucosal nodular lesions (Fig. 2).
Histology from the ileal biopsy. It reveals 3 coccidioidomycosis spherules, denoted by arrows. The spherule on the right-hand side is actively releasing endospores.
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Biopsies of ileal lesions did not reveal any malignancy but did show numerous CM spherules (Fig. 3).