Case #2:

Clinical Presentation:
26 year old man from Mexico with malaise, dyspnea and fever. Chest X-Ray shows a pleural effusion.

Clinical Diagnoses:
Pulmonary Tuberculosis
Bacterial Pneumonia


Case 2 Image 1:
Histopathologic section of pleural biopsy demonstrating large spherules containing endospores
Case 2 Image 2:
lactophenol-blue staining of teased hyphal growth of mold-like fungus, cultured at 25-37oC, showing alternating rectangular structures along hyphae.
Case 2 Image 3:
Culture of pleural fluid on Sabouraud agar incubated at showing white "cottony" growth.

Discussion:
Microbiologic Diagnosis: Coccidiomycosis
Laboratory cultures are infectious and lab-acquired infection can occur. This fungus is endemic to arid regions in Mexico and the US Southwest. Arthrospores (the rectangular structures in Image 2) from soil are inhaled and infect the lung. Infection is often asymptomatic but may cause an influenza-like illness with fever and cough ("Valley Fever"). Disseminated disease and Erythema Nodosum may also occur.