Coccidioidomycosis

Synonyms

San Joaquin valley fever; Desert rheumatism

Definition and Characteristics

This infection may be asymptomatic, a self-limited "flu-like" illness, or a typical pneumonia, often with mediastinal adenopathy. Pneumonia usually resolves completely but in 5-10% of cases there is a residual granuloma or thin walled cavity. Chronic upper lobe bronchiectasis is the least common outcome. Some patients with primary coccidioidomycosis have skin rashes (erythema nodosum or marginatum) with arthralgias or frank arthritis. These symptoms are due to an immunological reaction to the fungus, not to spread of infection; these patients have an excellent prognosis.

Dissemination outside the lung is the most serious manifestation of this disease. It can occur early in the course of infection and present like miliary tuberculosis. More often patients present with symptoms related to extra-pulmonary dissemination. The most common sites of dissemination are skin, bones and