Differential Diagnosis for Worsening Coccidiomycosis Infection and Adrenal Insufficiency

• Single Most Likely Diagnosis:
  • Adrenal insufficiency: This is a likely diagnosis because both worsening coccidiomycosis infection and adrenal insufficiency can present with similar symptoms such as fatigue, weight loss, and hypotension. Adrenal insufficiency can be a complication of disseminated coccidiomycosis, where the infection spreads to the adrenal glands, leading to their dysfunction.
• Other Likely Diagnoses:
  • Disseminated coccidiomycosis: This is a likely diagnosis as it can cause a wide range of symptoms including fever, night sweats, weight loss, and fatigue, similar to adrenal insufficiency. The infection can spread to various parts of the body, including the lungs, skin, bones, and central nervous system.
  • Sepsis: Sepsis is a possible diagnosis as both worsening coccidiomycosis infection and adrenal insufficiency can lead to a systemic inflammatory response, which may progress to sepsis if not properly managed.
• Do Not Miss Diagnoses:
  • Waterhouse-Friderichsen syndrome: This is a rare but life-threatening condition caused by adrenal hemorrhage, often due to severe infection, which can be a complication of disseminated coccidiomycosis. It presents with sudden onset of shock, abdominal pain, and fever.
  • Addisonian crisis: This is a life-threatening complication of adrenal insufficiency, characterized by severe hypotension, dehydration, and electrolyte imbalances. It requires immediate medical attention.
• Rare Diagnoses:
  • Histoplasmosis: Although less common, histoplasmosis is another fungal infection that can cause similar symptoms to coccidiomycosis, including fever, fatigue, and weight loss. It can also disseminate and affect the adrenal glands.
  • Blastomycosis: This is another fungal infection that can cause a range of symptoms similar to coccidiomycosis, including pulmonary and disseminated disease. It is less common than coccidiomycosis but should be considered in the differential diagnosis, especially in endemic areas.