CTICasesDisseminated Coccidioidomycosis with Miliary Pattern
Imaging findings
A 41-year-old woman with weeks of malaise, cough, fever, headache, and B symptoms had right lower lobe peripheral consolidation with a small effusion and scattered nodular opacities. After failing antibiotics, CT a month later shows widespread randomly distributed micronodules (miliary), some larger, with surrounding fuzzy ground glass, plus a discrete area of consolidation. She had recently visited family in the Central Valley.
Key takeaways
Disseminated coccidioidomycosis can present as a diffuse random micronodular (miliary) pattern with surrounding ground-glass halos, mimicking viral pneumonias such as varicella or herpes, and should be considered with appropriate travel to endemic regions like the Central Valley. Unlike histoplasmosis, coccidioidal nodules often do not calcify and may leave non-calcified satellite nodules that persist for years in an asymptomatic patient after treatment, and should not be mistaken for persistently active infection.
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