Pulmonary Coccidioidomycosis Presenting as Pneumothorax in an Immunocompetent Adult

Coccidioides spp are a dimorphic fungi that are endemic to the southwestern United States. Infection with Coccidioides spp, known as coccidioidomycosis or commonly known as Valley fever, is primarily caused by inhalation of spores, with most cases occurring in California and Arizona. Patients presenting with coccidioidomycosis can have widely varying clinical manifestations, ranging from asymptomatic carriage to severe disseminated disease. Occasionally, a pulmonary cavitary lesion can form as part of pulmonary infection, occurring approximately in 5% of patients with pulmonary coccidioidomycosis. Cavities that are larger or adjacent to the pleura may rupture and cause a pneumothorax. The authors have presented the case of a 43-year-old immunocompetent female who presented with pleuritic chest pain and was found to have a right-sided pneumothorax on chest x-ray. Surgical exploration revealed an apical bleb with pathology showing Coccidioides spp. This case highlighted the importance of evaluation for pulmonary coccidioidomycosis in patients who present with spontaneous pneumothorax and have had exposure to an endemic region.