P1318 - Eosinophilic Gastroenteritis, Ascites, Small Bowel Obstruction, and Urinary Retention: An Atypical Manifestation of Disseminated Coccidioidomycosis

Colby Adamson, DO¹, Yizhong Wu, MD¹, Pavia Muringathuparambil, MD¹, Layla Kutty, BSA², Emily Bensema, MS², Sameera Vohra, MD¹, Tauqeer Yousuf, MD¹
1Baylor Scott & White Medical Center - Round Rock, Round Rock, TX; 2Texas A&M School of Medicine, Round Rock, TX

Introduction: Coccidioidomycosis is a fungal infection caused by fungus endemic to the Southwestern United States. Around 40% of cases present with pulmonary symptoms following initial exposure, while others may remain asymptomatic for months to years. Around 1% of infected patients develop disseminated disease which may affect the skin, joints, CNS, and can rarely involve the GI tract. Diffuse eosinophilic inflammation of the gastrointestinal and genitourinary tracts is a rare manifestation of disseminated coccidioidomycosis.

Case Description/

Methods: We present a 57 year old male with history of uncontrolled type 2 diabetes mellitus who first presented to the ED with UTI like symptoms empirically treated with antibiotics as an outpatient. He later presented with two days of abdominal pain and urinary retention. Blood count was notable for marked eosinophilia. Imaging showed small bowel obstruction (SBO), ascites, and thickening of the distal esophagus and urinary bladder. Diagnostic paracentesis yielded eosinophilic ascites. EGD and colonoscopy with biopsies showed eosinophilic inflammation in the esophagus, stomach, duodenum, and large bowel consistent with eosinophilic gastroenteritis (EGE). Prostatic and urinary bladder biopsies also showed diffuse eosinophilic inflammation. Further history revealed the patient had previously lived in Arizona. Imaging of the chest led to discovery of a large cavitary lung lesion in the right upper lobe. Lung biopsy demonstrated fibrosis, inflammation, and necrosis suggesting infectious etiology. Additional testing showed positive Coccidioides antibody titer and lung biopsy culture. SBO spontaneously resolved with supportive therapy. He was treated with Amphotericin B inpatient with improvement in his eosinophilia and was discharged on high-dose Fluconazole.

Discussion: This is an atypical presentation of disseminated coccidioidomycosis with extensive eosinophilic infiltration across multiple organ systems manifesting as EGE, SBO, ascites, and urinary retention. Eosinophilia is a well-known immunologic response to certain infections, however, widespread eosinophilic inflammation of the gastrointestinal and genitourinary tracts in the setting of disseminated coccidioidomycosis has rarely been reported. This case emphasizes the importance of considering disseminated fungal infections in the differential diagnosis of unexplained eosinophilia and visceral organ dysfunction, particularly in patients with pertinent geographic exposure and immunocompromised status.

Disclosures:
Colby Adamson indicated no relevant financial relationships.
Yizhong Wu indicated no relevant financial relationships.
Pavia Muringathuparambil indicated no relevant financial relationships.
Layla Kutty indicated no relevant financial relationships.
Emily Bensema indicated no relevant financial relationships.
Sameera Vohra indicated no relevant financial relationships.
Tauqeer Yousuf indicated no relevant financial relationships.

Colby Adamson, DO¹, Yizhong Wu, MD¹, Pavia Muringathuparambil, MD¹, Layla Kutty, BSA², Emily Bensema, MS², Sameera Vohra, MD¹, Tauqeer Yousuf, MD¹. P1318 - Eosinophilic Gastroenteritis, Ascites, Small Bowel Obstruction, and Urinary Retention: An Atypical Manifestation of Disseminated Coccidioidomycosis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.