Pulmonary infection due toin the southwestern United States: not all miliary disease is tuberculosis and coccidioidomycosis.

BACKGROUND: is a rare cause of skin and/or central nervous system (CNS) infection with a high mortality rate. Dissemination to other organs, including the lungs, is rare. Despite worldwide distribution, this disease entity is underrecognized. Delay in diagnosis may contribute to high mortality.

CASE SUMMARY: A 17-year-old Hispanic male living in Arizona on immunosuppressive therapy for Castleman's disease presented with new cutaneous lesions and cough and was found to have miliary pulmonary disease on chest imaging. He was suspected of having disseminated coccidioidomycosis or tuberculosis, but skin biopsy revealed amebae. Skin and lung biopsy tissue confirmed the presence ofby real-time PCR. Additional imaging revealed CNS involvement. Despite initial good appearance and initiation of multidrug antimicrobial therapy, he developed multiorgan failure and died within 17 days of presentation.

CONCLUSION: This is the first published case of miliary lung disease caused by. Infection can affect multiple organ systems with poor outcomes even in the setting of early antimicrobial therapy.should be considered in patients with miliary lung disease.