Disseminated cutaneous coccidioidomycosis masquerading as lupus pernio

Coccidioides immitis, a pathogenic fungus endemic to arid regions, is the etiologic agent of cutaneous coccidioidomycosis. Primary cutaneous coccidioidomycosis is rare. The majority of cutaneous coccidioidomycosis infections are caused by dissemination of the fungus from the lungs to the skin. Diagnosing cutaneous coccidioidomycosis often can be difficult because it can mimic a variety of other clinical conditions. We present a case of a 45-year-old man presenting with cutaneous coccidioidomycosis on the tip of his nose. This patient had pulmonary symptoms in addition to his cutaneous findings, leading to a diagnosis of disseminated coccidioidomycosis.