Large airway obstruction secondary to endobronchial coccidioidomycosis

When clinically apparent, coccidioidomycosis usually presents either as an interstitial pulmonary infiltrate or, later in its course, a parenchymal nodule often with cavitation. The present report concerns a young adult woman whose presentation was one of shortness of breath with wheezing and stridor, secondary to a localized endobronchial coccidioidal granuloma producing nearly complete obstruction of the right mainstem bronchus. Such a presentation has not been reported previously in an adult. The possible association of serious fungal disease with previous jejunoileal bypass surgery is discussed.