Pulmonary Coccidiodomycosis Presenting as a Mass, an Uncommon Disease Entity in Ethiopia.

Coccidiodomycosis is a disease caused by the spores of the fungi coccidiodes immitis and pulmonary coccidiodomycosis comes after inhalation of the spores which are mainly found in desert areas of the United States, central and South America. Reported cases from outside the endemic areas have always history of travel to these areas. There are no reports so far from Ethiopia or the whole Africa. We report here a case of pulmonary coccidodomycosis with no history of travel to such areas. A 24 years old female patient from Samre, South-Eastern Tigray, presented with right side chest pain and productive cough of yellowish sputum which sometimes is blood streaked. She had completed anti-tuberculosis treatment without any improvement. With a preliminary diagnosis of pulmonary mass, surgical exploration was made and histology of the excised tissue showed appedrances consistent with pulmonary coccidioidomycosis. There was marked clinical and radiological improvement after three weeks of treatment with ketoconazole. Though there are no reported cases from Ethiopia and Africa as a whole, Coccidiodomycosis should be considered as differential diagnosis especially for patients from arid areas like that of our patient before any empirical treatment.