The first imported case of pulmonary coccidioidomycosis in Korea

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.