Abstract | November 8, 2021
Unusual Pain in the Butt: A Gluteal Abscess from Coccidioidomycosis
Learning Objectives
- Identify proper management and outpatient care of patients with coccidioidomycosis gluteal abscess.
Introduction: Coccidioidomycosis is a fungi found commonly in the Southwestern United States often discussed as a respiratory infection, it is known to be “the great imitator” and present as infections elsewhere in the body. Extrathoracic nonmeningeal coccidioides infections occur in < 1% of all coccidioides infections and commonly occur in immunocompromised hosts. Most immunocompromised hosts of extrathoracic nonmeningeal coccidioides infections are patients with HIV or those receiving chronic immunosuppressive therapy. There have been only 4 previous reported cases of coccidioidomycosis causing gluteal abscesses.
Case Presentation: We present a case of a 74 year old female, with extensive medical history including Sarcoidosis and Pulmonary Fibrosis on chronic Prednisone therapy, who presented with weakness and left buttock pain x 2 days. Patient was admitted for sepsis secondary toESBL E.coli UTI and left buttock cellulitis, with no abscess at time of admission. During the complicated admission, there was worsening skin breakdown that led to exploration exploration and drainage of abscess on day 7 of admission.
Final Diagnosis: Left buttock cellulitis with abscess measuring 3 x 2 x 7 cm, determined during surgical procedure with wound culture growing Coccidioides Immitis and Posadasii and Enterococcus Faecium.
Follow up: There was abscess recurrence on subsequent admission requiring additional wound debridement. Patient has outpatient treatment regimen consisting of Isovuconazonium with plan for 6 month treatment duration and wound care home visits. With complicated gluteal abscess management, in addition to management of other complex comorbidities, this case was a great example of teamwork within multiple disciplines. With the various specialists on board, there was abundant communication amongst all parts of the medical team. Also, it was excellent clinical decision making to employ further investigation and intervention before there was extension of infection into bone. We have seen poor outcomes in other patients with Coccidioides abscesses which developed osteomyelitis.
