Coccidiodomycosis: Patient Zero

I have finally started taking a serious look at First Aid for Step 1. I’ve hyperbolically approached every single standardized test I have taken as a moment that would radically dictate my future, but this exam has the most finite consequences for my career. While trying to google the rash that can present with coccidiodomycosis, the second image was this head in a jar:


I obviously had to procrastinate to figure out who this is. Coccidiomycosis, or San Joaquin Valley Fever, is a fungal infection found in the southwestern United States and dry, arid areas of South America. Fun fact that probably won’t be on boards (or may?? who knows): the incidence of San Joaquin Valley fever increases after earthquakes, as spores are aerosolized with the dust thrown up by the shaking.

So who is Domingo Ezcurra? He is the man with the first documented case of coccidiodomycosis (as the sign says). Mr. Ezcurra was hospitalized in 1891 in Buenos Aries, Argentina where he was cared for by Dr. Alejandro Posadas, who is credited with discovering the disease. Posadas would follow Ezcurra for seven years, documenting the progression of the disease. When Mr. Ezcurra passed away, Dr. Posadas preserved his head, which shows the lesions of coccidiomycosis. The jar still is displayed today in South America, and allegedly makes appearances during mycologist conferences in the continent. The next case presentation of coccidiodomycosis occured 35 years after Ezcurra’s death, which may explain why we don’t call it Buenos Aries Fever (San Joaquin Valley is in California and I guess stole Argentina’s thunder).

Did Mr. Ezcurra consent to having his head put in a jar? We probably will never know. Should Mr. Ezcurra’s head still be on display if he did not consent? This brings up a point of contention among the ownership and display of historical pathological specimens that are still housed in medical schools and museums. Briefly, if we are going to apply the contemporary ethics surrounding the use of biospecimens, we probably should remove them from display in a respectful manner. Assuming there was not a consent process that was in place, Mr. Ezcurra’s wishes at death should be honored. His head is clearly identified, and we could not keep is head under the guise of a de-identified specimen. On the other hand, such thinking provides us with a steep slope among specimens on display. Should we apply this line of thinking to the display of mummies, or Otzi the ice man? Would it only apply to cultures and individuals where we can conceptualize the burial process and what an individual in a particular culture would “reasonably” prefer after death? It quickly becomes wildly impractical.

The use of pathologic specimens, especially those that were collected before the rise of contemporary consent processes pose a conflict of our own understanding of contemporary research ethics and the continuing use of specimens for promoting knowledge that were not collected with our contemporary procces.

With that..on to paracoccidiomycosis…

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