19. Case history A 71-year-old male subject regularly spends several winter months in Arizona to play golf in the sun. Last March he experienced a gradual onset of fever and a headache, followed by a non-productive cough, myalgia and profound fatigue. His local physician diagnosed bronchopneumonia on chest radiograph, and prescribed azithromycin. The antibiotic provided no benefit, and ultimately the patient received two more courses of different empiric antibiotics. He returned home with continued cough and fatigue, even though the fever had abated somewhat. Two months following the initial onset of symptoms, a bronchoscopy was performed, and cultures grew Coccidioides species.
20. Other presentations Months to years following a symptomatic or asymptomatic infection, the affected lung may show complete resolution or an area of calcified or uncalcified pulmonary nodule similar radiographically to cancer. Microscopic examination of excised tissue identifies the organism. Occasionally the nodule liquefies to form a thin-walled cavity, which may close spontaneously or remain and become a nidus for suprainfection or spontaneous pneumothorax. Extrapulmonary dissemination can be identified in nearly all tissues, although skin and soft tissue, bones and meninges are the most common sites of dissemination. Chronic fibrocavitary pneumonia is seen infrequently, with chronic cough and dyspnoea, night sweats and weight loss, and lung fibrosis with thick-walled cavities. From BMJ Best Practice
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