A case of coccidioidomycosis with unique clinical features

Primary coccidioidomycosis, occurring in a microbiologist whose initial symptoms were cough, fever, night sweats, and chest pain, was unique, because for six months following infection his sera remained nonreactive, and his chest roentgenograms showed no lesions. Throughout this period, his sputa continued to yield Coccidioides immitis. His skin test, which showed negative results 12 days after the onset of symptoms, became positive for coccidioidomycosis eight months later. Spherule formation by C immitis cultures was demonstrated in human pleural fluid medium at 40 degrees C within four to six days and in the internal organs of a mouse inoculated with an arthrospore suspension. After six months of rest and without specific antibiotic treatment, the patient's sputa became negative and his clinical recovery was complete. We emphasize culture isolation and accurate identification of C immitis in diagnosis, and serology in the assessment of therapy.