Pulmonary coccidioidomycosis.

Coccidioidomycosis is a fungal disease endemic in the southwestern desert area of the United States. The infection is acquired by inhalation of arthrospores, and 60% of the infections are asymptomatic. Chest radiographic abnormalities are common and may even be seen in asymptomatic cases. In patients with acute infection, segmental or lobar consolidation and nodular or patchy pulmonary opacities are frequent. Hilar and mediastinal adenopathy may be present in 20% of cases, usually with parenchymal findings. A small pleural effusion may occur in 20% of cases. Approximately 5% of patients with primary disease are left with chronic, residual lesions of the lung. These consist of nodules, cavities, pneumonia, adenopathy, pleural effusion, fibrosis, bronchiectasis, and calcification. Rarely, in about 0.5% of cases, the infection may disseminate to any organ. The chest radiograph demonstrates a miliary or reticulonodular pattern and mediastinal adenopathy. Overall the disease is benign in nature; but patients with severe, progressive pulmonary or disseminated disease often require medical and occasionally surgical management.