Disseminated Coccidioidomycosis Presenting as Septic Shock with Multiorgan Failure

Figure 1

Autopsy findings and figures. (a) The normal lymph node architecture is replaced with granulomatous inflammation with abundant Coccidioides fungal organisms (hematoxylin and eosin stain 20X magnification. (b) Lymph node: Grocott-Gomori’s methenamine silver stain (GMS) highlights Coccidioides organisms at 20X magnification. Note empty spherules and spherules filled with endospores. (c) Lung alveolar spaces are filled with caseating granulomatous inflammation with abundant Coccidioides spherules with and without endospores (hematoxylin and eosin stain 20X magnification). (d) Lung: GMS stain highlights Coccidioides spherules in the lung tissue. (e) Left lung: innumerable diffuse tan nodules show miliary spread in the upper and lower lung lobes with predominance in the upper lobes in the lungs. The lungs were grossly boggy and congested; the left lung weighed 1250 grams (mean 400 grams). (f) Right lung: innumerable diffuse tan nodules showing miliary spread in the upper and lower lung lobes with predominance in the upper lobes in the lungs. The lungs were grossly boggy and congested; the right lung weighed 1400 grams (mean 450 grams). (g) Lymph nodes are diffusely enlarged and display a homogenous cut white/tan surface. (h) Axial plane view of the CT scan of the lungs showing military pattern of distribution of innumerable centrilobular and paraseptal pulmonary nodules in a random/miliary pattern of disease. (i) Axial plane of the CT scan of the abdomen and pelvis showing multiple enlarged lymph nodes along the periaortic distribution, right external iliac, and internal iliac chains.

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