Tuberc Respir Dis.  2009 Mar;66(3):220-224. 10.4046/trd.2009.66.3.220.

Pulmonary Coccidioidomycosis in Immunocompetent Patient

• Kim SW
• Oh JY
• Kim EJ
• Park GM

• KMID: 1846384
• DOI: http://doi.org/10.4046/trd.2009.66.3.220

Abstract

Coccidioidomycosis is a fungal infection caused by the soil fungus, Coccidioides immitis, which is endemic to the south-western United States. However, the incidence of coccidioidomycosis has recently increased due to the increase in overseas travel to endemic areas. We report a case of pulmonary coccidioidomycosis diagnosed in an immunocompetent person. A 28-year-old female, who had lived in Phoenix, Arizona, USA for 2 years, was admitted for an evaluation of persistent cough with fever lasting for 2 weeks. The chest X-ray and Chest CT revealed multifocal patchy consolidation and ground-glass opacity in both lungs as well as multiple enlarged right hilar and paratracheal lymph nodes. A percutaneous needLe biopsy of the main mass-like consolidation confirmed mature spherules of Coccidioides immitis in lung tissue. Pulmonary coccidioidomycosis should be considered in patients presenting with persistent cough with fever and a history of travel to or immigration from an endemic area.

Keyword

Fungi; Coccidioidomycosis; Cough; Fever

MeSH Terms

Adult
Arizona
Biopsy, Needle
Coccidioides
Coccidioidomycosis
Cough
Emigration and Immigration
Female
Fever
Fungi
Humans
Incidence
Lung
Lymph Nodes
Soil
Thorax
United States
Soil

Figure

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  Figure 1 Chest PA and Chest CT on the admission day show multifocal patchy consolidation and ground-glass opacity (GGO) in RUL, GGO in LUL and mediastinal lymph node enlargement.

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  Figure 2 Microscopic finding shows multiple scattered granulomas with central necrosis (H&E stain, ×200).

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  Figure 3 Microscopic finding shows immature spherule (white arrow) and mature spherule (black arrow). Mature spherules contain degenerated endospores (H&E stain, ×400).

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  Figure 4 The walls and contents of spherules are PAS positive (A), GMS positive (B) and mucicarmine negative (C).

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  Figure 5 Chest PA and Chest CT on the post-fluconazole treatment day 14 show decreased consolidation in RUL, disappeared ground-glass opacity (GGO) in LUL and improved mediastinal lymph node enlargement.

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