Conclusion
This case illustrates the potential for immunologic
extrapulmonary manifestations during acute pulmonary coccidioidal
infection and the value of a complete history in patients residing
within endemic regions. The patient’s occupational history led the
admitting team to include fungal infection in the differential diagnosis
despite initial pulmonary workup suggesting malignancy. Diagnosis of
coccidioidomycosis can be difficult, as signs and symptoms may be
relatively nonspecific and resemble other respiratory diseases or lung
malignancies. In our case, recognition of the cutaneous manifestations
and rheumatologic symptoms of this disease aided in making the correct
diagnosis. While radiographic imaging studies help make a diagnosis of
coccidioidomycosis, initial findings may be unremarkable or share
similarities with other diseases, such as malignancy in the case of our
patient. Therefore, histopathological studies from lung biopsy and
serology studies were used to make a definitive diagnosis of
coccidioidomycosis.