A fatal case of disseminated coccidioidomycosis in Louisiana.

We are reporting a fatal case of coccidioidomycosis, which is an uncommon mycotic infection in Louisiana. The patient was a 21-year-old, apparently immunocompetent, pregnant black woman who had fever of unknown origin for 6 weeks. She had recently moved from Arizona. Despite her progressively worsening condition, the patient delivered a baby girl who has been doing well. An exhaustive workup and a laparotomy failed to lead to the diagnosis. The diagnosis was established by trans-bronchial biopsy a day before her death. At autopsy, disseminated coccidioidomycosis was observed. A review of the mycology records of Charity Hospital of New Orleans revealed this to be the second case of coccidioidomycosis in 20 years. Coccidioidomycosis should be considered in the differential diagnosis of fever of unknown origin in Louisianians who have lived in endemic areas, especially in pregnant patients, who are at an increased risk of disseminated infection.