Pulmonary coccidioidomycosis

(A) Chest radiograph shows consolidation in right lower lung zone (arrow) and right hilar enlargement (arrowhead).
(B) Mediastinal window of contrast-enhanced computed tomography (CT) (5 mm collimation) scan obtained at the level of bronchus intermedius shows enlarged right hilar (arrowhead), subcarinal, and paraesophageal lymph nodes (arrows).
(C) CT scan obtained at the level of the right middle lobe bronchus shows parenchymal consolidation in the right middle lobe and enlarged subcarinal lymph nodes (arrows).
(D) Photomicrograph of the surgical biopsy specimen shows granulomatous inflammation and fibrosis with infiltration of multinucleated giant cells, eosinophils, and lymphocytes (hematoxylin and eosin stain, x100).
(E) Photomicrograph shows a yeast form developing a spherule of Coccidioides immitis (arrow), which is engulfed by a multinucleated giant cell (arrowheads). The periodic acid-Schiff stain highlights its thick yeast wall (periodic acid-Schiff stain, x400). The patient was a 58-year-old man with a one-month history of dyspnea and fever.