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

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.