A 59-year-old patient, chofer, born in Jiquilpan, Mich and resident in Tijuana, B.C., with a nine-year history of diabetes mellitus, treated with intramedullary corticosteroids
He also mentioned a history of apparently bacterial pneumonia 18 months before, treated with antibacterial agents.
It was characterized by lesions of three months of evolution, located in the glabelar region, nose and left paranasal area.
The lesions were nodular, slightly elevated, ulcerated, granulomatous background and blood crusts, 1-2 cm in diameter.
The diagnosis was made with positive direct examination and culture for Coccidioides spp.
The chest X-ray was normal and the intradermal reaction was positive.
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He was treated with itraconazole 400 mg daily for four months and for gastric intolerance had to be replaced by oral terbinafine 500 mg daily for five months.
After suspending the treatment, the patient presented with a flogosis of both knees and purulent material was removed through fistulas.
C. posadasii was isolated and admitted for treatment with amphotericin B.
