Scalene Lymph Node Involvement in Primary and Disseminated Coccidioidomycosis

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Abstract
In only 2 previous instances has a positive scalene node biopsy been reported in coccidioidomycosis, and in neither report was clinical information about the extent of the disease given. Six cases are reported in which a diagnosis of coccidioidomycosis was made by scalene node biopsy. Only 2 patients suffered disseminated disease. A 3rd had a pulmonary residual which remained stable during a follow-up period of 2 years. In the other 3 patients, although there was fear of dissemination, the clinical course and multiple serological studies provided no evidence of dissemination; and it is concluded that these patients had benign primary coccidioidomy-cosis. These data, as well as a review of clinical and pathologic evi-dence in the literature, indicate that involvement of the scalene node with coccidioidomycosis occurs in both primary benign infections and as part of disseminated disease. It is concluded that the scalene node biopsy may be a useful method of obtaining an early diagnosis of coccidioidomy-cosis; however, other clinical and serologic observations are more important with respect to prognosis.