Coccidioidomycosis in a patient with lymphoma. Spherulation in human pleural fluid medium

In a Caucasian woman who had had a giant follicular lymphoma for 21 months a small lesion developed in the upper lobe of the left lung. Excision, histologic study, and culture of the lesion were performed. Of the many stained sections, only one revealed endospore-containing spherules within the caseous necrosis of a granuloma, and only four spherules were identified. On agar medium the same tissue yielded a fast-growing fungus that produced arthrospores alternating with empty cells, typical of Coccidioides immitis. The arthrospore suspension was inoculated intraperitoneally into a mouse and into a medium of human pleural fluid at 40 C. Spherules containing endospores developed in the internal organs of the mouse and in the pleural fluid medium. The phylogeny of C. immitis is briefly discussed.