Coccidioidomycosis and neck mass 'single lesion' disseminated disease

Coccidioidomycosis is a fungal disease endemic to parts of the southwestern United States, parts of Mexico, and parts of Central and South America. Headache and sore throat may be primary manifestations of the disease in its non-disseminated form, and laryngeal involvement has been reported. Except for the very rare appearance of supraclavicular nodes, neck nodes have not been previously reported. In two patients, a neck mass was the only manifestation of disease. In the first patient, excision was curative; in the second, treatment with ketoconazole resulted in cure. These two patients represent an example of "single lesion" disseminated disease. Coccidioidomycosis should be added to the list of causes of neck masses.