Hemoptysis Associated with a Lower-Lobe Mass

Abstract

A 20-year-old man was admitted to the hospital with a 3-year history of annual episodes of submassive hemoptysis associated with a vague left-lower-lobe infiltrate. Work-up, including lung resection for recurrent bleeding, demonstrated an extensive granulomatous mass involving the entire left lung. Pathology of tissue revealed the spherules of Coccidioiodes immitus. No evidence of fungal dissemination was identified, and the patient was treated for chronic progressive pulmonary coccidioimycosis (CPPC). This case represents a unique presentation of CPPC, being remarkable for the absence of fever and lack of the lower-respiratory-tract symptoms or constitutional signs and symptoms that have been seen in other reported cases of CPPC.