Primary pulmonary lesions sometimes resolve, leaving nodular coin lesions that must be distinguished from neoplasms and TB or other granulomatous infections. Sometimes, residual cavitary lesions develop that may vary in size over time and often appear thin-walled. Although dissemination does not occur from these residual foci, a small percentage of these cavities fail to close spontaneously. Hemoptysis or the threat of rupture into the pleural space may occasionally necessitate surgery. Progressive coccidioidomycosis may develop a few weeks, months, or occasionally years after primary infections, which may occur long after leaving endemic areas.
Symptoms often are nonspecific, including low-grade fever, anorexia, weight loss, and weakness.
Extensive pulmonary involvement may cause progressive cyanosis, dyspnea, and discharge of mucopurulent or bloody sputum. Extrapulmonary lesions are usually focal, involving one or more tissue sites in bones, joints, skin, subcutaneous tissues, viscera, brain, or meninges. Draining sinus tracts sometimes connect deeper lesions to the skin. Localized extrapulmonary lesions often become chronic and recur frequently, sometimes long after completion of seemingly successful antifungal therapy. The diagnosis can be established by culturing infected body fluids or tissue specimens or by visualizing C. immitis spherules in sputum, pleural fluid, CSF, exudate from draining lesions, or silver or PAS-stained biopsy specimens.