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Curious Case of a Year-Long History of Cold Subcutaneous Abscesses

Frani, Ian Adrian F., BSN, MD*; Asad, Shadaba, MD

Infectious Diseases in Clinical Practice: March 2019 - Volume 27 - Issue 2 - p e5–e7
doi: 10.1097/IPC.0000000000000707
Case Report
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Cold subcutaneous abscess (CSA) is an abscess lacking classic inflammatory signs. This is a case of a 27-year-old incarcerated African American man who presented with 1-year history of soft, painless, mobile, masses on his limbs. Chest computed tomography scan showed diffuse reticulonodular infiltrates with right lower lobe mass. Computed tomography scan of the right upper extremity showed fluid density with no deep tissue involvement. Coccidioides complement fixation titers are 1:64, IgG 1.315, and IgM 0.242. Lung biopsy and CSA aspiration showed thick walled black spherules with endospores consistent with disseminated coccidioidomycosis (DCM). Cold subcutaneous abscess is a rarely reported manifestation of DCM. Defective cell-mediated immunity and inhibition of inflammation were thought to play a role in DCM and CSA pathogenesis. Cold subcutaneous abscess can remain unnoticed because of lack of inflammation. Our patient has longest time a CSA lasted without other symptoms of DCM. It is important to recognize it early to uncover a potentially dangerous disease.

Cold subcutaneous abscess (CSA) lacks classic inflammatory signs like erythema, warmth, and tenderness. The authors present a case of a 27-year-old incarcerated male who presented with acute fever and a 1-year history of small, mobile, non-tender masses on his extremities. He was later diagnosed with disseminated coccidioidomycosis (DCM) with lung and skin involvement. CSA is a rarely reported manifestation of DCM and can remain unnoticed. Early recognition is important to uncover a potentially dangerous disease.

From the *Department of Geographic Medicine and Infectious Disease, Tufts Medical Center; and

Department of Infectious Disease, University Medical Center, Infection Control University Medical Center of Southern Nevada, Las Vegas, NV.

Correspondence to: Ian Adrian Fanoga Frani, BSN, MD, 800 Washington St, Box 238, Boston MA 02111. E-mail: ianfranimd@gmail.com.

The author has no funding or conflicts of interest to disclose.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.