Case 126

1. Prepared by Dr. Sabesan Balasinkam, visiting Howard University Pathology Resident and reviewed by Dr. Sean Zhang

A patient presented to the hospital with fevers and shortness of breath. Upon evaluation he was found to be afebrile, normotensive with a normal heart rate. Chest X ray revealed moderate sized pneumothorax and small nodular opacity in the left lung. Review of past medical records indicated that two years ago patient was seen in a different state for cough, intermittent night sweats and weight loss. At the time, cavitary lesions were seen on CT scan. Endobronchial brushings identified Coccidioides infection. Patient was placed on fluconazole and followed up with CT scans.
The patient moved to this region a few days prior to current presentation and was advised by his previous infectious disease doctor to follow up regarding Coccidioides infection. Chest tube was placed and blood and bronchoalveolar lavage samples were taken for cultures. Filamentous fungus was isolated along with Neisseria species (Non-gonococcus and non-meningococcal) and group B Streptococcus. The filamentous fungus was identified as Coccidioides posadasii.
Which of the following characteristics describes Coccidioides?