Coccidioidal meningitis diagnosed by skin biopsy

We present a patient with coccidioidal meningitis whose diagnosis was not confirmed until a skin biopsy was performed. Because he lived in an area where coccidioidomycosis is not endemic, his meningitis was at first attributed to tuberculosis or sarcoidosis. After a verrucous lesion from the face was biopsied and the diagnosis substantiated, the patient responded well to consolidation therapy consisting of intrathecal amphotericin B and oral ketoconazole.