Pulmonary Coccidioidomycosis: Clinical Features

Comments:
Coccidioidomycosis - Clinical Presentation (continued from the previous image): Most patients with pulmonary coccidioidomycosis present with a self-limited community-acquired pneumonia. A small number of patients develop pulmonary complications, including fibrocavitary lung lesions, chronic pneumonia, miliary lung involvement, pleural effusion, empyema, or acute respiratory distress. About 3% to 5% patients develop chronic infection which may require life-long antifungal treatment.

The diagnosis of pulmonary coccidioidomycosis may be missed in non-endemic regions if the patient's travel history is overlooked. Variation in virulence among different strains of Coccidioides has been observed. The initial infection offers long-term protection from reinfection.

This image from a wedge biopsy of lung shows miliary involvement in a patient with pulmonary coccidioidomycosis. Numerous epithelioid granulomas are scattered throughout the specimen. See higher magnification in the next several images.