CTICasesDisseminated Coccidioidomycosis in Pregnancy
Imaging findings
Chest radiograph of a pregnant patient at 28 weeks gestation shows a diffuse, uniformly hazy appearance with tiny, ill-defined nodules. Chest CT confirms a classic miliary pattern composed of innumerable tiny, randomly distributed nodules throughout both lungs, with relative sparing of the dependent right middle and lower lobes. Mild mediastinal and hilar lymphadenopathy is also present. Serology subsequently confirmed active Coccidioides infection.
Key takeaways
Pregnancy, particularly in the third trimester, is a major risk factor for the dissemination of coccidioidomycosis due to relative immunosuppression and hormonal influences. Disseminated disease frequently presents with a miliary pattern on chest CT, which can mimic miliary tuberculosis or sarcoidosis. Safe management requires non-teratogenic antifungals like amphotericin B.
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