Coccidioidomycosis is an endemic disease found in the southwestern part of
North America. Travellers who visit the endemic area may carry the infectio
n. We report a case of pulmonary coccidioidomycosis in a 74-year-old woman.
She was healthy before visiting Arizona, U.S.A twice. After returning home
, she began to complain of intermittent dry coughing. The symptom was mild,
however, and she was treated symptomatically. Later a chest radiograph, wh
ich was taken 4 years after the onset of the symptom, showed a solitary pul
monary nodule in the right upper lobe. By percutaneous needle aspiration, a
few clusters of atypical cells were noted in the necrotic background. A ri
ght upper and middle lobectomy was done. A 1.5 x 1.5 x 1.2 cm sized tan nod
ule was present in otherwise normal lung parenchyma. Microscopically, the n
odule consisted of aggregates of multiple solid granulomas inside of which
was mostly necrotic. Neutrophils and nuclear debris were scattered along th
e periphery of the necrotic foci. Numerous multinucleated giant cells were
associated with the granulomas. In the necrotic area, mature spherules of C
occidioides immitis, which were 30-100 mu m in diameter, were present. They
contained numerous endospores which ranged from 5 to 15 mu m and were also
noted in multinucleated giant cells. The diagnosis of coccidioidomycosis w
as made. She is doing well after the resection.