A Case of Gastrointestinal Coccidiomycosis With Bowel Perforation Secondary to Relapsing DLBCL

Coccidioides is a fungus endemic to the Southwestern United States, known for causing Valley Fever. While typically asymptomatic or presenting as a respiratory tract infection, rare cases of disseminated infection to the peritoneum have been reported. The patient in this case study presented with a small bowel obstruction, requiring an exploratory laparoscopy showing evidence of an inflammatory mass with a jejuna-colic fistula with adherence to the spleen. The patient underwent splenectomy with a cholecystectomy and small bowel resection. Intraabdominal cultures revealed Coccidioides, and so he started long-term antifungal treatment. The patient was also initiated on salvage chemotherapy for DLBCL, and ultimately received CAR T-Cell therapy at a tertiary center. This case report highlights a unique presentation of gastrointestinal Coccidioides infection, in the setting of an immunocompromised host with a hematologic malignancy. It also provides insight into the therapeutic challenges clinicians face when treating complicated patients such as this who require urgent chemotherapy while risking further immunosuppression in the setting of active infection.