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Weekly Chest CasesArchive of Old Cases

Case No : 916 Date 2015-05-18

  • Courtesy of Sung-Joon Park, Hwan-seok Yong, Eun-young Kang / Korea University Guro Hospital
  • Age/Sex 50 / F
  • Chief ComplaintLeft lower chest pain (onset: one week ago)
  • Figure 1
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  • Figure 3
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  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Coccidioidomycosis
Radiologic Findings
Multifocal patchy consolidations can be seen in the left lower lobe of the lung with an internal air-bronchogram on chest radiograph. Chest CT also reveals multifocal consolidations with an air-bronchogram in the left lower lobe of the lung. There were no obstructive lesions in the central airways, and no abnormally enlarged mediastinal or hilar lymph nodes. On follow-up chest radiographs, these lesions were shown to be aggravated within a short interval, suggesting an inflammatory lesion such as pneumonia. Pathologic specimen from the percutaneous needle aspiration biopsy revealed chronic granulomatous inflammation with focal neutrophilic exudate, consistent with
coccidioidomycosis
Brief Review
Coccidioidomycosis is a systemic fungal infection caused by Coccidioides Immitis via the inhalation of fungal arthrospores. A peculiar geographic distribution has been reported for this illness, occurring mostly in individuals from semi-arid areas with similar weather and soil conditions such as the Southwestern United States (California, Arizona and Texas), Mexico, Central America (Guatemala and Honduras) and South America (Colombia, Venezuela, Bolivia, Paraguay and Argentina).
In Korea, the 1st imported case was reported in 1976, with about 30 cases having been reported domestically thus far. Interestingly, in 3 of these cases, the patients had no travel history and they had lived only in Korea. This suggests the possibility of the naturalization of the Coccidioides species in Korea.
Sixty percent of patients show no symptoms. Therefore, the definite diagnosis of Coccidioidomycosis is made through the demonstration of this organism by culture or histology.
On imaging, Coccidioidomycosis can be seen as solitary or multifocal consolidations, or nodules which may cavitate. Approximately one-fifth of cases can be seen with hilar lymphadenopathy or pleural effusion. These lesions can be disseminated to nearly any tissue. For differential diagnosis, bacterial or fungal pneumonia, as well as lung cancer should be considered.
References
1. Diane C.Strollo, Coccidioiomycosis, Diagnostic Imaging Chest 2nd edition, Amirsys publishing Inc., 2012.
2. YK Kim, Epidemiological characteristic study of domestic and imported mycoses, Korea Centers for Disease Control and Prevention, 2012
3. Capone D, Marchiori E, Wanke B, Dantas KE, Cavalcanti MA, Deus Filho A et al. Acute pulmonary coccidioidomycosis: Ct findings from 15 patients. Br J Radiol 2008;81:721-724
Keywords
Lung, Infection, Fungal infection,

No. of Applicants : 94

▶ Correct Answer : 1/94,  1.1%
  • - National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
▶ Correct Answer as Differential Diagnosis : 7/94,  7.4%
  • - Kyoto University , Japan Akihiko Sakata
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - McGill , Canada ilan azuelos
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Medicheck health care , Korea (South) Chae Lim
▶ Semi-Correct Answer : 27/94,  28.7%
  • - Goa Medical College , India Paresh Desai
  • - Wuhan Union Hospital , China Qiguang Cheng
  • - University of British Columbia , Canada Amr Ajlan
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Asan Medical Center , Korea (South) Jooae Choe
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - IRSA La Rochelle , France Denis Chabassiere
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Niigata University , Japan Atsushi Uehara
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - Asan medical center , Korea (South) Sang Young Oh
  • - Asan Medical Center , Korea (South) Soyeoun Lim
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Okinawa Kyodo Hospital , Japan Shoko Iraha
  • - MT agarwal hospital,Mulund, Mumbai , India ASHISH SARODE
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - NASA SCANS , India RAKESH BHATIA
  • - CHU Poitiers , France CHAN paul
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Gifu Central Hospital , Japan Haruo Watanabe
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