Fig. 4.15 (a) PA with circle highlighting cavitary (coin) lesion representing coccidiomycosis. Note suggestion of air-fluid level. (b) Lateral showing subtle cavity (due to overlying shoulders) lesion

Symptoms: Include chills, weight loss, productive cough, chest pain, and arthralgias.

Diagnostic tests: Include sputum smear (KOH test), sputum culture, serology, CXR, and the Coccidioidin/Spherulin skin test.

Treatment: The acute disease almost always goes away without treatment. Bed rest and treatment of flu-like symptoms until fever disappears may be recommended. Disseminated or severe disease should be treated with amphotericin B, ketoconazole, fluconazole, or itraconazole.

Non-infectious Granulomatous Disease

The following are non-infectious granulomatous conditions:

•Sarcoidosis

•Hypersensitivity Pneumonitis (HP)

•Vasculitis-granulomatosis diseases

–Wegener’s

–Lymphocytic

–Bronchocentric allergic (Churg–Strauss)

•Langerhans granulomatosis (eosinophilic granuloma, histiocytosis) (LCG)