Non-endemic Pulmonary Coccidioidomycosis in Taiwan-A Case Report

Abstract

Coccidioidomycosis is a dustborne infection caused by the dimorphic fungus Coccidioides immitis. Infections are endemic to certain regions of the southwestern United States. Most patients with primary pulmonary coccidioidomycosis are asymptomatic. Inhalation of fungal spores is the only established mode of infection, and spores may be carried on dust particles. Coccidioidomycosis is frequently unrecognized as a diagnosis because of the lack of suspicion in a non-endemic area. We described a case of coccidioidomycosis manifesting as a persistent pulmonary mass and diagnosed in Taiwan, a non-endemic area. This patient initially was treated with anti-tuberculosis drugs owing to the presence of necrotizing granulomatous inflammation on repetitive lung biopsies. The diagnosis of coccidioidomycosis was confirmed after wedge resection of the right middle lobe of the lung through minithoracotomy. We also reviewed the related literature concerning the epidemiology, clinical manifestations, diagnosis and treatment of coccidioidomycosis.