Disseminated cutaneous coccidioidomycosis in a liver transplant patient

INTRODUCTION The increasing incidence of allogeneic transplants in Coccidioides-endemic areas such as the southwestern United States and Latin America highlights the importance of considering reactivation of donor coccidioidomycosis in transplant recipients. We report the case of a 42-year-old Nicaraguan woman who had multiple firm, violaceous subcutaneous nodules 1 month after her orthotopic liver transplant. Histopathology of a biopsy specimen, immunodiffusion assay, and donor serologic testing results were consistent with disseminated cutaneous coccidioidomycosis secondary to donor reactivation. Screening of donors in Coccidioides-endemic areas with serology, organ culture, and chest radiography should be considered before transplantation. Recipients in endemic areas may benefit from prophylactic antifungal therapy.