Laboratory Work-Up -- Cavitary Lesion in the Right Upper Lung Lobe


An elective flexible bronchoscopy obtained brushings, bronchial washes, and transbronchial biopsies at the right upper lobe cavity site. All cultures from these specimens were negative for fungi, and the biopsies and cytologic specimens were also negative for malignancy. The patient remained asymptomatic and was monitored for the next several months. A follow-up flexible bronchoscopy 5 months later showed necrotic exudate and chronic inflammation, but histologic studies were again negative for fungi, acid-fast bacteria, and malignancy. However, a bronchial aspirate at that time showed light growth of Coccidioides immitis, and this culture was confirmed at an outside laboratory by DNA probe analysis. Lactophenol cotton blue slide preparations of the Coccidiodes culture are presented ( IMAGE 5, IMAGE 6, and IMAGE 7 ).



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