Cavitary Coccidioidomycosis: Experience in a Tuberculosis Hospital Outside the Endemic Area

¹ Pulmonary Disease Service, Department of Medicine, USAF Hospital Scott, Scott Air Force Base, Illinois

At a military hospital far from the endemic area for Coccidioides immitis, 24 cases of cavitary coccidioidomycosis were seen in approximately six years; all were referred with the initial impression of cavitary tuberculosis. When evaluating a patient with a cavitary lesion in the lungs, a history of residency, however brief, within the endemic area should arouse suspicion. Although lack of such a history makes coccidioidomycosis extremely unlikely, a past history of known acute coccidioidomycosis or pneumonia, influenzal illness, or unexparticularly valuable, for cavitary lesions are invariably residuals of acute primary infection. When symptoms and physical examination were not helpful, skin tests, cultures, serologies, x-ray findings and geographic history proved essential for diagnosis. The majority of the patients had no specific therapy, and in those in whom surgery was attempted a significant number of complications were noted.