Coccidioidomycosis as a Diagnostic Consideration: Expanding the Pulmonary Differential

We present a case of a previously healthy 50-year-old man with a two-week history of progressive exertional dyspnea and intermittent sharp pain in the left chest and lower rib area. He then developed cough and low-grade fever, with chest X-ray imaging demonstrating possible left lower lobe consolidation suggestive of bacterial pneumonia. Given the geographic location where the patient lived, with environmental exposure to farming dust, and symptoms that did not improve with antibiotic treatment, alternative diagnoses were considered. The patient was eventually diagnosed with coccidioidomycosis via a positive antibody screen and fungal bronchoalveolar lavage studies that grew Coccidioides immitis. He was started on fluconazole with improvement. This case report highlights the clinical presentation, diagnosis, and treatment of this disease, as well as laboratory results noted during subsequent follow-up, which may aid clinicians in the long-term management of these patients.