Discussion
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,