Arthroconidia in Lung Tissue: An Unusual Histopathological Finding in Pulmonary Coccidioidomycosis

Publication date: Available online 1 August 2017
Source:Human Pathology
Author(s): Thea Brennan-Krohn, Edward Yoon, Michiya Nishino, James E. Kirby, Stefan Riedel
Coccidioides immitis/posadsii 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 CT 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 presentations; culture remains the most reliable method for definitive diagnosis.



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