PMC10178290_01
Computed tomography scan results of our patient at the initial visit. (A) A 20 mm-sized nodule is present in the upper lobe of the left lung. (B) An 8 mm-sized cavity can be noted within the nodule during the course of the disease.
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A computed tomography scan revealed a well-circumscribed nodule, 20 mm in size, in the upper lobe of the left lung (Figure 1A). The nodule had formed a cavity with a maximum diameter of 8 mm during the course of the disease (Figure 1B).
Morphology of a nodule in the upper lobe of the left lung. (A) The inner dotted line shows necrosis of lung tissue (hematoxylin and eosin staining, 400x magnification). (B) Arrows indicate rupturing spherical bodies (Grocott methenamine silver staining, 400x magnification). (C) Arrows indicate scattered endospores (Grocott methenamine silver staining, 500x magnification).
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Histological examination revealed necrosis of lung tissue (Figure 2A), spherical bodies characteristic of Coccidioides (Figure 2B), and some endospores (Figure 2C).
Coccidioides immitis culture obtained from the resected specimen. (A) Day 4 of culture. Growth of filamentous fungi is observed. (B) Day 6 of culture. Aerial mycelium is identified. (C) Day 11 of culture. Aerial mycelium increased and became cottony. (D) Barrel-shaped arthroconidia (Lactophenol cotton blue staining, 1000x magnification).
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The culture derived from the mashed nodule eventually became positive for C. immitis in 11 days (Figure 3), which was confirmed by DNA sequencing of the ITS region and the D1/D2 region of the 28S ribosomal RNA gene.
Computed tomography scan results of our patient 2 years after resection. No new lesions and no lung deterioration.
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Follow-up examination was performed every 2 months without antifungal therapy, and the patient has been asymptomatic for 2 years after surgery with no worsening outcomes on imaging examinations (Figure 4).