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Primary cutaneous coccidioidomycosis in a human immunodeficiency virus-positive patient: Case report and literature review

Coccidioidomycosis is a recognized opportunistic infection among persons infected with human immunodeficiency virus (HIV). Compared with immunocompetent persons, HIV-infected patients are at risk of symptomatic and progressive disease since the control of coccidioidal infection requires intact cellular immune function. We report a case of a 28-year-old HIV positive woman, who presented with 3 months' history of widespread pruritic hyperpigmented nodular skin lesions. The histopathological evaluation of excisional biopsy was consistent with cutaneous coccidioidomycosis. Chest X-ray showed no lesion in the lung. Abdominopelvic ultrasound revealed no abnormality. The patient had end-stage HIV disease (AIDS) with CD4 lymphocyte cell count of 66 cells/μL, and HIV-1 RNA viral load of 128,763 copies/ml. Even though up to 50% of patients with coccidioidomycosis could develop cutaneous involvement, this tends to occur following pulmonary and or systemic disease. Primary cutaneous coccidioidomycosis is rare, and this possibility should be considered in the evaluation of HIV-positive patients, even in nonendemic areas of the world.