By Gary M. White, MD

Coccidioidomycosis A cutaneous ulcer on the shoulder caused by coccidioidomycosis.

Coccidioidomycosis is caused by infection with Coccidioides immitis. In the US, coccidioidomycosis infection usually occurs in the Southwest, in states such as Arizona, New Mexico, and in the San Joaquin Valley of California. Infection initially occurs through the respiratory tract. Infection may be limited to the lungs, or may disseminate in about 1 out of 200 persons. Those immunocompromised (e.g., HIV, organ transplant, hematogenous malignancy), pregnant women, or those of African American, Filipino, or Mexican descent are at higher risk.


Skin lesions usually appear as verrucous nodules. Pulmonary coccidioidomycosis can cause edematous papules, nodules, and plaques to develop abruptly during the onset of the acute febrile illness. Ulcers may develop. Pulmonary coccidioidomycosis can also precipitate erythema nodosum.


Consultation with an infectious disease specialist is recommended. In the past, treatment involves amphotericin B until a clinical response is achieved and antibody titers decline. Then, the amphotericin B can be replaced with an oral azole such as itraconozole or fluconazole.

Additional Pictures

Erythema nodosum from Coccidioidomycosis infection.


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