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Presentation

A 42-year-old female with a 30-pack/year smoking history presented to the Emergency Room with a cough, shortness of breath and chest pain. She had moved to Virginia a few weeks prior to presentation. A computed tomography (CT) scan showed a 1 x1.1 x1 cm well-defined pulmonary nodule in the right upper lobe without other significant findings. She was discharged with pulmonology follow up. It was revealed that a nodule was present on a previous scan, and a positron emission tomography (PET) scan showed low avidity uptake. Given her smoking history, a fine needle aspiration was performed to evaluate for malignancy vs. infection. Necrotizing granulomas were identified without malignant cells, and stains were negative for bacterial, fungal and acid-fast organisms. A fungal organism later grew on Sabouraud dextrose agar (SDA), and lactophenol cotton blue stain of the organism showed barrel-shaped arthroconidia, which confirmed the diagnosis.    

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