Coccidioidomycosis in Thailand: a diagnostic challenge in a non-endemic country

Coccidioidomycosis is endemic to the Western Hemisphere and is rarely encountered in Asia, including Thailand. A detailed history, particularly of prior travel to endemic areas, is critical in refining the differential diagnosis and considering coccidioidomycosis.Here, we report an early adolescent male who presented with fever, non-productive cough and pleuritic chest pain of 1 month's duration. Radiologic findings were suggestive of pulmonary tuberculosis. Antituberculosis therapy was started, but there was no clinical improvement. However, on specific questioning, we learned that he had recently returned from Los Angeles, USA, before the onset of the illness. Hence, pulmonary coccidioidomycosis was suspected based on his travel history to an endemic region and the recognition that its clinical presentation can closely mimic tuberculosis. The diagnosis was confirmed by the results of pathology, cultures and molecular methods of transbronchial lung biopsy specimens. The patient gradually improved after fluconazole treatment.