Coccidioidomycosis or the San Joaquin Valley fever is a granulomatous disease caused by the soil-dwelling dimorphic fungus Coccidioides immitis or Coccidioides posadasii. Ocular involvement typically occurs secondary to dissemination and is considered rare. The uvea is the most common site of intraocular disease. Coccidioidal uveitis should be considered in any patient with apparent idiopathic, granulomatous iridocyclitis, or choroiditis who has lived or traveled through endemic areas, including Arizona, New Mexico, west Texas, parts of Central America, Argentina, northwest Mexico, and the San Joaquin Valley in California. Skin and serologic testing confirm exposure to Coccidioidal antigen, but tissue biopsy is necessary for definitive diagnosis. Prompt recognition and treatment with systemic and local antifungal therapy is critical to save life, the eye, and potentially vision. Amphotericin B has proven efficacy but is limited by toxic adverse effects. Systemic and intravitreal azole therapy are efficacious against coccidioidomycosis. Oral azole therapy may be used primarily for less severe disease and for maintenance therapy. Without timely, appropriate treatment, many eyes will progress to requiring enucleation.
- Ampel NM. Coccidioidomycosis. In: Fauci AS, Braunweld E, Kasper DL, editors. Harrison’s Principles of Internal Medicine. New York: McGraw-Hill Book Company; 2008. p. 1247–9.Google Scholar
- Centers for Disease Control and Prevention (CDC). Increase in Coccidioidomycosis – California, 2000–2007. MMWR Morb Mortal Weekly Rep. 2009;58:105–9.Google Scholar
- Foos RY, Zakka KA. Coccidioidomycosis. In: Pepose JS, Holland GH, Wilhelmus KR, editors. Ocular infection and immunity. St. Louis: Mosby; 1996. p. 1430–6.Google Scholar
- Fusaro RM, Bansal S, Records RE. Some unusual periorbital dermatomes. Ann Ophthalmol. 1998;30:391–3.Google Scholar
- Granoff DM, Libke RD. Coccidioidomycosis. In: Feigin RD, Cherry JD, editors. Textbook of pediatric infectious diseases. Philadelphia: WB Saunders; 1981. p. 1488–500.Google Scholar
- Hagele AJ, Evans DJ, Larwood TR. Primary endophthalmic coccidioidomycosis: report of a case of exogenous primary coccidioidomycosis of the eye diagnosed prior to enucleation. In: Aiello L, editor. Coccidioidomycosis: Papers from the Second Symposium. Tucson: University of Arizona Press; 1967. p. 37–9.Google Scholar
- Rixford E, Gilchrist TC. Two cases of protozoan (coccidioidal) infection of the skin and other organs. Johns Hopkins Hosp Rep. 1896;I:209–68.Google Scholar
- Tsang CA, Tabnak F, Vugia DJ, Benedict K, Chiller T, Park BJ. Increase in reported coccidioidomycosis–United States, 1998–2011. MMWR Morb Mortal Weekly Rep. 2013;62(12):217–21.Google Scholar
- Ventocilla M. Ocular Coccidioidomycosis. Medscape, 28 Jan 2015. Web, 25 Oct 2015. http://emedicine.medscape.com/article/1204191-overview.