Affiliations: Children's Hospital of Orange County and University of
California, Irvine, CA, USA | Department of Radiology, Children's Hospital of Orange
County, Orange CA, USA | Department of Infectious Diseases, Children's Hospital
of Orange County, Orange CA, USA
Note: [] Correspondence: Dayna Chin, M.D., Children's Hospital of Orange
County, University of California, Irvine, Pediatric Resident, PGY-3, CA, USA.
Tel.: +1 562 318 9955; E-mail: dayna.chin@gmail.com
Abstract: A correct diagnosis can be elusive when a rare disease is present.
Such was the case when two teenagers were admitted to a children's hospital.
Due to their clinical presentation, imaging, and laboratory results, final
diagnoses and treatment were delayed. The first patient, a 15-year old Chinese
female with systemic lupus erythematosus, presented with cough and fever. She
was found to have a right upper lobe consolidation with central cavitation.
Subsequent chest imaging revealed a miliary pattern, and RIPE therapy was
started to cover Mycobacterium tuberculosis. The second patient was a
previously healthy, 14-year old African American female, who presented with
progressive spinal deformity and an enlarging right parietal scalp lesion. An
AFB sputum sample was positive, and spinal imaging showed a gibbus deformity,
prompting the initiation of RIPE therapy for tuberculosis. Both patients were
later found to have disseminated Coccidioidomycosis, a rare diagnosis that is
often mistaken for other etiologies. Both patients responded well to
fluconazole therapy.
