Pulmonary Coccidioidomycosis Manifesting as a Single Pulmonary Nodule-A Case Report and Literature Review

Abstract

A previously healthy 40-year-old man with pulmonary coccidioidomycosis presented with a solitary pulmonary nodule. The diagnosis was made by wedge resection with histological proof and a previously positive serology test for coccidioidomycosis IgG. The patient had suffered from left chest pain in 2003 when he worked in Arizona. A left lung nodular lesion was found by chest film, and pulmonary coccidioidomycosis was diagnosed at that time, on the basis of positive serum coccidioidomycosis IgG. He underwent anti-fungal treatment there for about 3 months, and the chest pain subsided. In May 2005, he visited our chest medicine outpatient department because of a recurrence of chest pain. The chest X-ray disclosed a 2.5 cm nodule in the left lung. A wedge resection was performed and histopathology of the lesion demonstrated caesous granulomatous inflammation with some Langerhan's giant cells. The Gomori methenamine silver (GMS) and periodic acid-Schiff (PAS) stains disclosed several spherules containing some small endospores. The histopathological picture was compatible with Coccidioides infection. Literature concerning the life cycle, manifestation, diagnosis, treatment, and pulmonary sequelae of coccidioidomycosis is also reviewed.