Disseminated coccidioidomycosis discovered during routine skin cancer screening

A 78-year-old white man presented for routine dermatologic examination. A 4x4-mm erythematous papule was noted on the left upper back. It was asymptomatic and previously unnoticed by the patient. The results of a shave biopsy revealed a large spherule with granular cytoplasm diagnostic of coccidioidomycosis. Chest x-ray revealed a 1.8-cm right upper lobe mass. The complement fixation antibody titer for cocci was 1:128. The patient was treated for disseminated coccidioidomycosis with oral fluconazole. The epidemiology, diagnosis, and management of coccidioidomycosis are discussed.