A case study of imported pulmonary coccidioidomycosis

Abstract

Coccidioidomycosis is an endemic disease of the Western hemisphere. The cases in non-endemic areas are mostly imported. Determining a history of exposure is critical for performing the diagnosis of coccidioidomycosis, especially for cases occurring in a non-endemic area. In this study, a 71-year-old Chinese male presented to our hospital with chronic cough and malaise, and was found to have a mass in the middle lobe of right lung. He had been visiting Arizona, USA for four months before admission. Pulmonary coccidioidomycosis was confirmed by the results of histopathological examination after lobectomy. Typical microscopic features of Coccidioides are definitely diagnostic, but need be differentiated from other budding yeast infection or carcinoma histopathologically.

Fig. 1

Chest computed tomographic (CT) scan (a) Mediastinal window showing right hilar lymphadenopathy (white arrow); (b) Lung window showing a solid mass in the right middle lobe

Fig. 2

Hematoxylin and eosin (H&E) staining of fungal encapsulated spherules with endosporulation (white arrows), measuring 20–40 µm in diameter, found in the surrounding tissues and multinucleated giant cells

Fig. 3

Periodic acid-Schiff (PAS) staining of multiple fungal encapsulated spherules with endosporulation (white arrow)

Fig. 4

Periodic acid silver methenamine (PASM) staining of multiple capsule of fungal spherules known as Coccidioides (white arrow)