A Diagnostic Predicament: Disseminated Coccidioidomycosis Mimics Tuberculosis

Coccidioidomycosis is a chronic granulomatous infection caused by dimorphic fungus Coccidioides spp. Sporadic cases of this infection have been reported globally in non-endemic regions those are primarily associated with travel to areas of high endemicity in the United States of America, Central and South America. The manifestations of coccidioidomycosis are not very different from tuberculosis (TB), and therefore, can be mis-diagnosed as TB, especially in areas with high prevalence of TB. We present a case of a middle-aged Indian male who travelled to USA and subsequently developed cough, fever, malaise, cutaneous nodules and discharging sinuses that were mis-diagnosed as TB; till a histopathological examination and fungal culture established the diagnosis of coccidioidomycosis of the lung with dissemination to the skin. He was successfully treated with oral itraconazole without any recurrence. [