CTICasesPulmonary Coccidioidomycosis in a Transplant Recipient
Imaging findings
A renal transplant recipient (transplanted in 2019) presented with an acute febrile illness and cough and a large left upper lobe opacity with peripheral ground glass, scattered septal lines within the lobe, no cavitation, and adjacent low-attenuation lymph nodes with a somewhat narrowed airway. She had traveled extensively by van, including the southwestern United States. CT-guided biopsy with GMS stain showed coccidioides.
Key takeaways
A large consolidative opacity in an immunosuppressed transplant patient with travel to endemic (southwestern US) regions should raise opportunistic coccidioidomycosis, confirmed here by biopsy. The associated interstitial edema-like septal lines may reflect impaired lymphatic drainage from involved low-attenuation lymph nodes and increased lymphatic flow from inflammation; caution is advised about needle biopsy across the pleura given the risk of seeding coccidioides into the pleural space.
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