Primary diagnosis of disseminated fungal disease by fine-needle aspiration of soft-tissue lesions.

Two cases of disseminated fungal infections diagnosed by fine-needle aspiration of soft-tissue masses are presented. Both patients were initially treated on an outpatient basis for a presumed musculoskeletal disorder before the diagnostic biopsy was obtained. The first patient apparently contracted Coccidioides immitis infection while residing in Arizona, but the diagnosis was rendered on an aspirate of a buttock mass performed in Boston. The second patient, a non-insulin-dependent diabetic, was diagnosed with a cryptococcal abscess on an aspirate of a shoulder mass performed in the emergency room. The diagnosis of coccidioidomycosis was confirmed by culture and that of Cryptococcus by serology. Fungal infection was clinically unsuspected in both patients and the cytologic diagnosis facilitated rapid implementation of therapy.