title: Coccidioides immitis presenting as a mycelial pathogen with empyema and hydropneumothorax.
abstract: A previously healthy Caucasian male developed hydropneumothorax and a pleural peel filled with pleomorphic, septate hyphae. The only organism grown from cultures of the lung and pleural fluid was Coccidioides immitis, confirmed by exoantigen testing. Spherule-endospore forms were produced, however, following injection of the arthroconidial tissue isolate into BALB/c mice. The patient had a positive immunodiffusion complement-fixation test and developed a positive coccidioidin skin test during therapy. He recovered following thoracotomy and wedge resection of the ruptured coccidioidal cavity, and therapy with amphotericin B followed by fluconazole. The sole presence of the mycelial form of the dimorphic fungus C. immitis in the pleural space may have been due to a low CO2 partial pressure at that site secondary to a bronchopleural fistula. The case shows a distinctive and uncommon presentation of coccidioidomycosis which demonstrates the specificity of both the immunodiffusion complement-fixation assay in diagnosing this disease and the exoantigen test in confirming culture results.
authors.affiliation: Department of Infectious Diseases, Wilford Hall United States Air Force Medical Center, Lackland AFB, TX 78236.
authors.forename: M J
authors.initials: MJ
authors.lastname: Dolan
authors.forename: C P
authors.initials: CP
authors.lastname: Lattuada
authors.forename: G P
authors.initials: GP
authors.lastname: Melcher
authors.forename: R
authors.initials: R
authors.lastname: Zellmer
authors.forename: R
authors.initials: R
authors.lastname: Allendoerfer
authors.forename: M G
authors.initials: MG
authors.lastname: Rinaldi
mesh_terms: D000818:Animals; D000946:Antigens, Fungal / Q000032:analysis; D003045:Coccidioides / Q000254:growth & development* / Q000276:immunology; D003047:Coccidioidomycosis / Q000150:complications / Q000175:diagnosis / Q000382:microbiology*; D003168:Complement Fixation Tests; D016724:Empyema, Pleural / Q000209:etiology*; D005260:Female; D006801:Humans; D006872:Hydropneumothorax / Q000209:etiology*; D005779:Immunodiffusion; D008099:Liver / Q000382:microbiology; D008168:Lung / Q000382:microbiology / Q000473:pathology; D008297:Male; D051379:Mice; D008807:Mice, Inbred BALB C; D008875:Middle Aged; D010994:Pleura / Q000382:microbiology / Q000473:pathology; D013154:Spleen / Q000382:microbiology
chemical_list: D000946:Antigens, Fungal