[3] The early symptoms presented in combination with pulmonary abnormalities apparent on chest radiographs may lead to misdiagnosis of the disease as tuberculosis, histiocytosis, or pneumonia caused by Pneumocystis carinii.

[6] In 1976, a 4-year-old was reported developing the disease in Norway after purposely inhaling a large quantity of Lycoperdon spores to stop a nosebleed.

In another instance, a teenager spent 18 days in a coma, had portions of his lung removed, and suffered severe liver damage.

[4] In Wisconsin, eight teenagers who inhaled spores at a party presented clinical symptoms such as cough, fever, shortness of breath, myalgia, and fatigue within a week.

[3][8][9] Known species of puffballs implicated in the etiology of the published cases include the widespread Lycoperdon perlatum (the "devil's snuff-box", L. gemmatum) and Calvatia gigantea, both of the family Lycoperdaceae.