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The Uveitis Atlas pp 1–7Cite as

Coccidioidomycosis

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Abstract

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.

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Author information

Authors and Affiliations

  1. Vanderbilt Eye Institute, Department of Ophthalmology and Visual Sciences, Vanderbilt University School of Medicine, Nashville, TN, USA

    Gowtham Jonna & Anita Agarwal

  2. West Coast Retina Medical Group, San Francisco, CA, USA

    Anita Agarwal

Authors
  1. Gowtham Jonna
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  2. Anita Agarwal
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Corresponding author

Correspondence to Anita Agarwal .

Editor information

Editors and Affiliations

  1. Advanced Eye Center, PGIMER, Chandigarh, India

    Vishali Gupta

  2. Ophthalmology, University of Nebraska Medical Center, Omaha, Nebraska, USA

    Quan Dong Nguyen

  3. Department of Ophthalmology, Pitié-Salpêtrière University, Paris, France

    Phuc LeHoang

  4. University of Lausanne, Lausanne, Switzerland

    Carl P Herbort Jr.

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Jonna, G., Agarwal, A. (2018). Coccidioidomycosis. In: Gupta, V., Nguyen, Q., LeHoang, P., Herbort Jr., C. (eds) The Uveitis Atlas. Springer, New Delhi. https://doi.org/10.1007/978-81-322-2506-5_38-1

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  • DOI: https://doi.org/10.1007/978-81-322-2506-5_38-1

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  • Publisher Name: Springer, New Delhi

  • Print ISBN: 978-81-322-2506-5

  • Online ISBN: 978-81-322-2506-5

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