Pulmonary Coccidioidomycosis

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Abstract
Thirty-eight cases of pulmonary coccidioidomycosis were disclosed by review of the surgical pathology files of a general hospital in an area endemic for Coccidioides immitis. All lesions were localized inflammations, the chronic coccidioidal residual that evolves from primary coccidioidomycosis infection of the lungs in only a small percentage of cases. Peripheral location, contiguous visceral pleural involvement, and sharp demarcation from adjacent pulmonary parenchyma were macroscopic characteristics of these pulmonary nodules. Communication with a bronchus or bronchiole was frequently demonstrated. Central caseous necrosis and a variable, often polymorphic, peripheral inflammatory cell response were common microscopic features. Microscopic granulomas were noted both in contiguity with the principal lesion and in distant peribronchial and periseptal locations. Vascular involvement was present, albeit an un-common finding in this series. Differentiation from other granulomatous lesions of the lung rested principally on cultural or histologic identification of the Coccidioides immitis organism.

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