When observing patients suffering from coccidioidal granuloma, one is soon impressed by the fact that certain patients die despite any form of treatment while others experience remissions under suitable therapy. The disease usually involves the skin in either event, but the fatal and the nonfatal type have their own clinical characteristics. This became apparent to me during personal observation of 6 fatal cases and was confirmed by a cursory review of reported cases. Not all patients with fatal infection by Coccidioides immitis present an eruption characteristic of the fatal type. However, persons with the characteristic papillomatous nodules usually succumb rapidly to a miliary
dissemination of the disease—hence, this type might be termed miliary coccidioidal granuloma of the skin.
Jacobson1 classified the cutaneous manifestations of coccidioidal granuloma in three groups: (1) those involving the skin primarily (dermal); (2) those arising in the subcutaneous tissue and secondarily involving the skin
EPSTEIN E. PROGNOSTIC SIGNIFICANCE OF CUTANEOUS LESIONS IN COCCIDIOIDAL GRANULOMA. Arch Derm Syphilol. 1938;38(5):752–755. doi:10.1001/archderm.1938.01480170076008
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