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Coccidioidomycosis where you least expect it
  1. Nandu Nair1,
  2. Nandakishore Baikunje1,
  3. Giridhar Belur Hosmane1 and
  4. Sunil Kumar2
  1. 1Pulmonary Medicine, KS Hegde Medical Academy, Mangalore, Karnataka, India
  2. 2Pathology, KS Hegde Medical Academy, Mangalore, Karnataka, India
  1. Correspondence to Dr Nandu Nair; drnn.official{at}


An elderly man without history of travel presented with complaints of intermittent fever for 2 months, cough with scanty expectoration for 15 days and history of weight loss of 5 kg in 1 year. The chest X-ray and CT scan of the thorax showed dispersed centrilobular nodules and patchy subpleural consolidation in both lungs with mediastinal lymphadenopathy. He underwent bronchoscopy and bronchoalveolar lavage culture grew Pseudomonas aeruginosa. He was prescribed antibiotics based on culture sensitivity; however, patient continued to have symptoms. All relevant blood investigations were within normal limits. He underwent CT-guided biopsy of the right lung lesion during which clearing of the radio-opacities present in the initial CT scan and appearance of fresh lesions in different locations were observed. Migratory shadows were suspected. Fine-needle aspiration cytology showed features suggestive of coccidioidomycosis for which antifungals were started. After 1 month, he improved symptomatically and chest X-ray showed clearance of shadows.

  • Infectious diseases
  • TB and other respiratory infections
  • Pneumonia (infectious disease)
  • Travel medicine
  • Respiratory medicine

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  • Contributors NN: Worked on managing the patient as well as typing out this case report. NB: Checked and corrected the manuscript. SY: Reported cytology. NN, NB, GBH: Participated in patient management.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.