Unusual manifestation of Coccidioides immitis infection

Cavitary pulmonary disease secondary to coccidioidomycosis occurs in endemic areas of the southwestern United States. Significant hemoptysis requiring pulmonary resection may develop in patients with cavitary lesions. In rare instances hemoptysis may be due to the development of a fungus ball within the cavity, and such mycetomas may contain spherule and mycelial forms of Coccidioides immitis. A patient with a documented coccidioidal cavity who had hemoptysis is described in this report. Chest radiograph revealed a fungus ball within a left lower lobe cavity. The patient underwent left lower lobectomy and recovered without complications. Examination of the resected left lower lobe disclosed a cavity containing a fungus ball comprised of mycelial and spherule forms of Coccidioides immitis. A review of the literature found three reports of biphasic growth of this condition within a coccidioidomycosis cavity and two additional cases of radiographically diagnosed coccidioidal mycetoma. Discussion of the potentially contagious nature, the medical and surgical management, and the prognosis of coccidioidal mycetoma form the basis of this report.