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Kim, Oh, Kim, and Park: Pulmonary Coccidioidomycosis in Immunocompetent Patient
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2009; 66(3): 220-224.

Published online: 31 March 2009

DOI: https://doi.org/10.4046/trd.2009.66.3.220

Pulmonary Coccidioidomycosis in Immunocompetent Patient

Se Won Kim, M.D.1, Jin Young Oh, M.D.1, Eo-Jin Kim, M.D.2, Gun Min Park, M.D.1

1Department of Internal Medicine, University of Dongguk College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.

2Department of Pathology, University of Dongguk College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.

Address for correspondence: Gun Min Park, M.D. Departments of Internal Medicine, Dongguk University Ilsan Hospital, 814, Siksa-dong, Ilsandong-gu, Goyang 410-773, Korea. Phone: 82-31-961-7142, Fax: 82-31-961-7153, pgm1134@duih.org

Received 24 December 2008       Accepted 26 February 2009

Copyright©2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

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.

Keywords: Fungi, Coccidioidomycosis, Cough, Fever

Figures and Tables

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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