The skin window technique was utilized to study the cellular response in patients with various stages of coccidioidomycosis. No significant differences were observed in these patients when compared with a control group suggesting that the cellular response, as measured by this method, is normal in patients with coccidioidomycosis, regardless of the severity and extent of the disease process. The topical application of coccidioidin to the site of abrasion did not alter the response from that obtained with abrasion alone. The presence of a normal cellular response in patients with disseminated coccidioidomycosis and a negative coccidioidin skin test implies that anergy in this instance cannot be attributed to the failure of migration of mononuclear cells to the test site.
The histological appearance of the biopsies of the skin tests from a normal control with a negative skin test, from one with a positive test, and from a patient with disseminated coccidioidomycosis and anergy to coccidioidin all appeared similar with mononuclear cell infiltrates of approximately the same extent in the dermis. This discrepancy between the histological features and the clinical appearances of skin test sites provides additional evidence that delayed hypersensitivity of the coccidioidin skin test type is dependent on reactions other than the infiltration of mononuclear cells alone into the area.
NEWCOMER VD, LANDAU JW, LEHMAN R, ROWE JR. The Local Cellular Response in Patients With Coccidioidomycosis. Arch Dermatol. 1963;88(6):799–811. doi:10.1001/archderm.1963.01590240123021