PMC6335914_01
Right cheek cutaneous nodule, 1 x 1 cm. This figure appears in color at www.ajtmh.org.
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Africa, presented to the hospital with a 2-week history of subjective fever, drenching night sweats, worsening dry cough, and profound fatigue. A non-tender skin nodule on his right cheek appeared 2 days earlier (Figure 1).
Computed tomography with intravenous contrast of the chest revealing left upper lobe opacity and cavitation due to coccidioidomycosis (A, red circle) with near resolution of lesion noted on repeat imaging after 6 months of fluconazole therapy (B, blue circle). This figure appears in color at www.ajtmh.org.
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Computed tomography (CT) of the thorax with intravenous contrast revealed a large consolidated opacity in the left upper lobe with evidence of early cavitation (Figure 2A). After 6 months of oral fluconazole therapy, a repeat CT of the thorax with intravenous contrast revealed near resolution of the previous left upper lobe consolidation without any evidence of cavitation (Figure 2B).
Coccidioidal spherule (30 microm), thick walled, with active segmentation and endosporulation, surrounded by granulomatous tissue seen on light microscopy (H&E staining) from tissue biopsy of the cutaneous nodule. This figure appears in color at www.ajtmh.org.
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Disseminated coccidioidomycosis was confirmed when the fungal culture from the skin nodule grew Coccidioides species and subsequent tissue histopathology showed spherules (Figure 3).