The literature on pediatric extrapulmonary coccidioidomycosis
is limited. We reviewed the clinical course, diagnostic studies, treatment and outcomes of children with extrapulmonary coccidioidomycosis
followed at a tertiary care center in central California.
Retrospective study of 78 patients ≤21 years old with extrapulmonary coccidioidomycosis
diagnosed over 10 years (1/1/07–12/31/16).
The median age was 9.7 years (interquartile range, 4.5–14.8). The majority of patients were males (55%), Hispanic (65%) and without comorbid conditions (85%). Over two-thirds (68%) had concurrent pulmonary disease. Organ involvements included bones and joints (33%), mediastinum (19%), central nervous system (19%), cervical lymph nodes (15%), larynx (6%) and skin (5%). Most cases (84%) resolved and/or became stable on maintenance therapy, 14% experienced relapse and/or progressive disease, and 2% were fatal. Children ≥10 years of age tended to have >1 site of involvement (47% vs. 25%, P
= 0.06), and more relapsed/progressive/fatal disease (21% vs. 5%, P
= 0.06) compared with those <10 years. They also required longer durations of treatment (median, 611 vs. 349 days, P
= 0.02). Non-Hispanics were more likely to require >1 drug therapy (85% vs. 70%, P
= 0.04) and tended to have Coccidioides
complement fixation titers ≥1:32 (89% vs. 72%, P
= 0.04) compared with Hispanics.
Conclusions: Extrapulmonary coccidioidomycosis
in children can be severe and spread to multiple sites and requires prolonged treatment. Non-Hispanics and those ≥10 years of age are more likely to experience severe disease, suggesting a need for early recognition and intervention in these populations.