Lung nontumor

Topic Completed: 1 September 2011

Minor changes: 4 July 2020

Revised: 29 January 2019, last major update September 2011

Copyright: (c) 2003-2017,, Inc.

PubMed search: coccidioides immitis [title] pulmonary

Elliot Weisenberg, M.D.
Page views in 2019: 2,671
Page views in 2020 to date: 1,267
Cite this page: Weisenberg E. Coccidioides. website. Accessed July 7th, 2020.
Clinical features
  • Dimorphic fungus that reproduces by endosporulation, found in soil in Southwest US, San Joaquin Valley (California), Mexico, Central America
  • May induce chronic pneumonia with mass-like lesion resembling tuberculosis
  • Disease usually limited to lung, sometimes with regional lymph node involvement, usually in immunocompetent patients
  • In endemic areas, inhalation of spores usually leads to subclinical infection with delayed type hypersensitivity response
  • 10% of infected individuals develop "San Joaquin Valley fever" with fever, cough, chest pain, lung lesions, erythema nodusum
  • Disseminated disease is rare
  • In lab, hyphae form infectious arthrospores, requires careful handling
Gross description
  • Mass with necrotic center surrounded by fibrous tissue with concentric lamination
  • Fungus ball may fill preexisting pulmonary cavity
Microscopic (histologic) description
  • Granulomatous inflammation, large thick walled spherules contain variable sized daughter cysts
  • Pyogenic reaction occurs with release of endospores from rupture of spherules
  • Variable fibrocaseous granulomata, military disease, pyogenic inflammation
  • Immature nonendosporulating spherules can resemble nonbudding forms of Blastomyces dermatitidis (Can Respir J 2008;15:377)
Microscopic (histologic) images

Images hosted on other servers:

69 year old man with a history of COPD

69 year old man with a history of COPD (cont.)

Various images - not necessarily lung

Cytology images

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lavage - immature
variant (GMS stain)

Positive stains
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