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.