Abstract
A 50's Japanese woman had lived in Arizona, United States, for about 30 years. A chest radiograph during a health examination in Japan revealed an abnormal shadow in the right lower lung field, and chest CT showed a 9-mm, smooth, rounded nodule located in segment 8 of the right lower lung. She was referred to our hospital, with no complaints and normal blood examination results. We performed right lower wedge resection with video-assisted thoracoscopic surgery (VATS) for the purpose of definitive or adjunctive treatment. She was histopathologically diagnosed with chronic pulmonary coccidioidomycosis with caseous necrosis of a granuloma containing numerous transparent pathogens with the shape of a large sphere. This was supported by consideration of her previous history of having lived in the United States. It is necessary to suspect coccidioidomycosis from previous travel histories to the United States and preoperative imaging findings before tissue culture or surgery because of the mycosis infection risk to surrounding people. Coccidioides species have the most infectious capacity of all fungi, but it is difficult to detect them using culture and serologic tests in the absence of symptoms. We must suspect chronic coccidiomycosis on considering travel to endemic areas and imaging findings of small nodules, and so must be careful to prevent occupationally acquired infection.
