Abstract
A 21-year-old healthy male who had traveled to Phoenix, Arizona, several times was admitted to our university hospital for evaluation of a coin lesion in his chest X-ray. A well-demarcated tumor 1.5 cm in diameter was seen in S3. Pulmonary tuberculosis was highly suspected by chest tomography and CT scan. Intracutaneous tuberculin skin reaction was negative. A specimen obtained by trans-bronchial lung biopsy was not large enough for diagnosis. Open lung biopsy was performed. Histological examination revealed granulomatous lesions with caseous necrosis, epithelioid cells, lymphoid cells, and foreign body giant cells. Close examination disclosed PAS reaction and Grocott's stain positive endosporulating spherules of Coccidioides immitis within the giant cells. Pulmonary coccidioidomycosis, which is a rare fungal disease found in certain endemic areas in America, was diagnosed.
