Tuberc Respir Dis.  2006 Jan;60(1):97-101.

Disseminated Coccidioidomycosis Presenting with Miliary Nodules

• Kim JH
• Hur GY
• Jung KH
• Jung HC
• Park DW
• Lee SY
• Lee SY
• Kim JH
• Shon JU
• Shin C
• Shim JJ
• In KH
• Kang KH
• Yoo SH

Abstract

Coccidioidomycosis is a rare systemic fungal infection in Korea. However, the incidence of coccidioidomycosis has recently begun to increase due to the increasing incidence of people traveling overseas to endemic areas. In previously reported cases of coccidioidomycosis in Korea, the radiographic findings usually showed a solitary pulmonary nodule, pleural effusion, cavitation, and hilar lymphadenopathy, but no miliary nodules. We report a case of disseminated coccidioidomycosis with miliary nodules in an immunocompetent patient. A 32 year old male, who had traveled in Corona, New Mexico, USA, was admitted for an evaluation of persistent cough with fever. Chest radiography revealed initially diffuse multiple small nodules that appeared to be miliary tuberculosis. However, a subsequent evaluation revealed that he had disseminated coccidioidomycosis.

Keyword

Fungi; Coccidioidomycosis; Pulmonary nodules

MeSH Terms

Adult
Coccidioidomycosis*
Cough
Fever
Fungi
Humans
Incidence
Korea
Lymphatic Diseases
Male
New Mexico
Pleural Effusion
Radiography
Solitary Pulmonary Nodule
Thorax
Tuberculosis, Miliary

Figure

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  Figure 1 Chest radiography (A) and high resolution computed tomography (B) on admission showed diffuse, multiple, and small nodules with interlobular septal thickening on both whole lung field.

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  Figure 2 Bronchoscopic examination showed whitish, nodular lesion on bronchial mucosa of left main bronchus (A) and histologic findings of specimens obtained by bronchoscopic biopy (B) showed a marked eosinophilic infiltration and a few spherules (hematoxylin and eosin, ×200).

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  Figure 3 Pustules on facial skin (A) and histologic findings of specimens obtained by excisional skin biopy (B) showed chronic granulomatous inflammation with thick-walled mature spherules containing endospores (hematoxylin and eosin, ×400).

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