Pulmonale infectie met Coccidioides immitis

– A man aged 42 who was referred to the outpatient department for Pulmonary Diseases because of a cough of two weeks‘ standing and fever up to 40°C, had recently spent 10 days in the desert (San Joaquin Valley, California). Physical examination revealed no distinct abnormalities. Radiologically, an infiltrative lesion in the left upper lobe of the lung was established, as well as swollen lymph nodes near the pulmonary hilus. Blood testing revealed leukocytosis and eosinophilia. Possibilities considered were tuberculosis and, because the patient had been in California, coccidioidomycosis. The Mantoux test and several Ziehl-Neelsen preparations were negative. However, the immunodiffusion test for Coccidioides immitis antibodies was positive. Also, C. immitis was cultured from the sputum. The diagnosis read ’pulmonary coccidioidomycosis with eosinophilia‘. Because of aggravation of the pulmonary lesions and eosinophilia, treatment with ketoconazole was instituted. This was the first time in the Netherlands that a human infection with the fungus C. immitis could be confirmed serologically as well.