What are less common pulmonary manifestations of coccidioidomycosis?

Updated: Aug 27, 2019
  • Author: Duane R Hospenthal, MD, PhD, FACP, FIDSA, FASTMH; Chief Editor: Michael Stuart Bronze, MD  more...
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Less commonly, diffuse coccidioidal pneumonia in immunocompetent hosts manifests as respiratory failure. This is due to either inoculation with a large number of spores or to hematogenous seeding of the lung at several sites.

Approximately 5% of pulmonary infections result in the formation of nodules. These typically cause no symptoms but may be indistinguishable from a neoplasm on radiologic studies without histologic examination.

Approximately half of these nodules resolve spontaneously. However, persistent nodules can eventually degenerate into thin-walled cavitations, which may erode into adjacent small airways or the pleural space, resulting in hemoptysis or pneumothorax. Rupture of a peripheral coccidioidal cavity into the pleural space is a complication that is most common in young male patients.

Patients with diabetes mellitus or preexisting pulmonary fibrosis (eg, from cigarette smoking) may develop a chronic fibrotic pneumonia process. These patients may present with chronic cough and systemic symptoms such as fever, night sweats, and weight loss, as well as local symptoms.

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