CTICasesCoccidioidomycosis Presenting as Lobar Pneumonia
Imaging findings
A patient with cough and fever had radiographic and CT findings of a left upper lobe lobar pneumonia with a little developing necrosis and airway spread of nodular foci to other lobes, which proved to be coccidioidomycosis. Seen a year later for an incidental large ascending aortic aneurysm, the pre-operative imaging showed residual non-resolving parenchymal disease that initially raised concern for tuberculosis.
Key takeaways
Coccidioidomycosis can present as a lobar pneumonia with necrosis and endobronchial spread, and characteristically leaves residual, non-calcifying parenchymal abnormalities that persist for years, unlike histoplasmosis which tends to calcify. This persistent residual can be mistaken for active tuberculosis, and coccidioidal pneumonia can also resemble blastomycosis.
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