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Hum Pathol. 2018 Jan;71:55-59. doi: 10.1016/j.humpath.2017.07.013. Epub 2017 Aug 1.

Arthroconidia in lung tissue: an unusual histopathological finding in pulmonary coccidioidomycosis.

Author information

1
Beth Israel Deaconess Medical Center, Department of Pathology, Boston, MA 02215; Boston Children's Hospital, Division of Infectious Diseases, Boston, MA, 02215.
2
Beth Israel Deaconess Medical Center, Department of Pathology, Boston, MA 02215.
3
Beth Israel Deaconess Medical Center, Department of Pathology, Boston, MA 02215; Harvard Medical School, Boston, MA 02215.
4
Beth Israel Deaconess Medical Center, Department of Pathology, Boston, MA 02215; Harvard Medical School, Boston, MA 02215. Electronic address: sriedel@bidmc.harvard.edu.

Abstract

Coccidioides immitis/posadasii presents in mycelial form with branching hyphae and arthroconidia when cultured in the laboratory. On histopathology, the presence of endospore-containing spherules is considered diagnostic of coccidioidomycosis. Here we report an unusual case of coccidioidomycosis with hyphae and arthroconidia in pulmonary tissue sections. A 49-year-old male patient with intermittently treated pulmonary coccidioidomycosis sought treatment for residual pulmonary complaints. A cavity in the left upper lobe was seen on computed tomographic scan. Due to minimal improvement of symptoms despite treatment with fluconazole, a left upper lobectomy was ultimately performed. Coccidioides mimmitis/posadasii was identified by culture and DNA probe from the lobectomy specimen. The histopathology showed a fibro-cavitary lesion, with arthroconidia and hyphal structures, but no typical endospore-forming spherules. While uncommon, C. immitis/posadasii may present with hyphae and arthroconidia on histopathology. Pathologists should be aware of this unusual presentation; culture remains the most reliable method for definitive diagnosis.

KEYWORDS:

Arthroconidia; Coccidioides immitis; Coccidioides posadasii; Coccidioidomycosis; Histopathology of endemic fungi; Laboratory diagnosis of Coccidiodomycosis

PMID:
28778515
PMCID:
PMC5936468
DOI:
10.1016/j.humpath.2017.07.013
[Indexed for MEDLINE]
Free PMC Article

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