Disseminated coccidioidomycosis with cutaneous manifestation

Coccidioidomycosis is a disease by airborne exposure of Coccidioides(C.) immitis, and endemic in the Southwest United States. Primary infection site is lung, and dissemination of the disease can occur depending on the host factors: race, immune status, pregnancy, etc. We report a Korean man with coccidioidomycosis disseminated to the skin, presenting the granulomatous papules on the face and trunk in addition to the pulmonary symptoms. Fungal spherules in the dermis were detected on the skin tissue section, and C. immitis were cultured from the skin tissue. The clinical symptoms were gradually improved with the systemic treatment of antifungal agents (amphotericin B and caspofungin). After more than 6 months of treatment, all of the pulmonary and cutaneous lesions were cleared, but fever persisted.