Images corresponding to illustrative case 2 (missed fungal disease). (A) BAL specimen (original magnification ×100, oil immersion) with GMS stain demonstrating dark spherical structures, originally misdiagnosed on cytopathology as P jirovecii but subsequently determined to be Coccidioides endospores. (B) Section of lung with hematoxylin and eosin stain (original magnification ×10) demonstrating a mixture of large thick-walled spherules containing variably sized endospores, diagnosed as invasive C immitis. (C) Section of lung (original magnification ×20) showing invasive C immitis as highlighted by GMS stain. (D) Magnification of area outlined in red (original magnification ×60) illustrating multiple ruptured Coccidioides spherules releasing endospores into surrounding lung tissue.