What imaging or lab findings are associated with Coccidioidomycosis pneumonia?

• A. Bilateral effusions with edema.
• B. Normal imaging.
• C. Widespread interstitial markings only.
• D. Unilateral infiltrates, with potential cavities or nodules; eosinophilia may be present.

Answer: (D)

Coccidioidal pneumonia usually shows localized, unilateral lung findings on imaging, often as a focal infiltrate that may include nodules and can cavitate. This pattern reflects the granulomatous inflammatory response to inhaled Coccidioides spores and is a hallmark of primary pulmonary coccidioidomycosis. In addition, eosinophilia can be seen as part of the body's immune reaction to the fungus, and serologic tests for coccidioidal antibodies (IgM/IgG) can support the diagnosis, especially in patients from endemic areas. By contrast, bilateral edema with effusions points more toward fluid overload or other conditions, normal imaging doesn’t explain symptoms, and a diffuse interstitial pattern is more typical of viral or atypical pneumonias, not the unilateral focal process described here.