Diagnosing coccidioidomycosis outside an endemic area. A recent case in Montreal, Quebec, Canada

A 65-year-old female with a long-standing controlled Crohn's disease was admitted in August 1979 to a Montreal hospital for investigation of a non-calcified RUL lung nodule. After an extensive work-up (negative bronchoscopy and mediastinoscopy showing a granulomatous reaction) she underwent thoracotomy; the nodule was enucleated and showed caseous material within a fibrous capsule. Cultures in mycology produced a heavy growth of Coccidioides immitis, a diphasic pathogenic fungus endemic in South Western USA, identified by its morphology in autoclaved cultures, reversion to the spherule phase in mice and a 1:80 immunofluorescent stain with both commercial and patient's serum. The patient, who travelled to Arizona three times in recent years, was soon discharged and remains apparently well. Because of inherent risks from handling cultures of C. immitis, the authors urge that, when coccidioidomycosis is considered clinically and epidemiologically, the pertinent information be transmitted to the laboratory.